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S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 1O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1
OR:08-00-FO20
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ______________________________________
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
[ ] Male [ ] Female
NICKNAME FOR THE ID
COURSE & SEC.
CONTACT NUMBER / S
RELIGION CITIZENSHIP Residence #
DATE OF BIRTH mm - dd - yyyy PLACE OF BIRTH Mobile #
ADDRESS E-mail Address & FaceBook Account
Home Address
Provincial Address
FATHER'S NAME MOTHER'S NAMES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
Seconday
College
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates ACADEMIC ACHIEVEMENTS (Please enumerate) OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 2O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
Academic Year 2012-2013 IDPICTURE
NAME OF ORGANIZATION : Pharmacy Dance Troupe
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG Go
Aldrin - Byron
Amascual
[ x ] Male Vice President -Internal [ ] Female
NICKNAME FOR THE ID Aldrin
COURSE & SEC.
CONTACT NUMBER / s
RELIGION Romsn Catholic CITIZENSHIP Filipino Residence #
DATE OF BIRTH 01-03-1992 PLACE OF BIRTH Tarlac, Tarlac Mobile # 09328429223
ADDRESS E-mail Address & FaceBook Account
Home Address
1218 Pacific Suites Dapitan cor. Santander St. Sampaloc, Manila
E-Mail [email protected]
Provincial Address 185 Poblacio 2 Gerona,Tarlac
Facebook www.facebook.com/thefight
FATHER'S NAME Alexander N. Go M.D.
MOTHER'S NAMES Catherine Nuyen A. Go M.D.
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned Year of Graduation Honors Received
Elementary
College of the Holy Spirit / Don Bosco Technical Institute 2004
Seconday Don Bosco Technical Institute - Tarlac 2008
College University of Santo Tomas
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates
DBTI – Student Council Business Manager 2007-2008
Taekwondo Varsity Captain 2007-2008
Service Emergency Volunteer Environmental Network Group (7G) Member 2006-onwardsACADEMIC ACHIEVEMENTS (Please enumerate) OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
Loyalty Awardee
Best in Taekwondo,
Best Leader in NSTP
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 3O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
PICTURE
NAME OF ORGANIZATION: Pharmacy Dance Troupe
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
LAPID
STEVEN JAIKKO GOZUM
[ X ] Male INTERNAL VICE PRESIDENT [ ] Female
NICKNAME FOR THE ID
JAIKKO COURSE & SEC. 3C - PHARMACY
CONTACT NUMBER / S
RELIGION ROMAN CATHOLIC CITIZENSHIP FILIPINO Residence #
900-2530
DATE OF BIRTH 04 – 17 - 1992 PLACE OF BIRTH PAMPANGA Mobile # 09228262417
ADDRESS E-mail Address & FaceBook Account
Home Address 1220 CORNER SANTANDER STREET, PACIFIC GRAND TOWER, DAPITAN, SAMPALOC, MANILA
E-Mail [email protected]
Provincial AddressSTO. NINO, GUAGUA, PAMPANGA
Facebook www.facebook.com/jaikko17
FATHER'S NAME DANIEL LAPID MOTHER'S NAMES BERNADETH LAPID
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
SAN NICOLAS LEARNING CENTER GRADE 1 VALEDICTORIAN
WHIZ KID ACADEMY GRADE 2 – GRADE 6 2005 SALUTATORIAN
Secondary O.B MONTESSORI CENTER INC. (ANGELES) 1ST – 4TH YEAR 2009
College UNIVERSITY OF SANTO TOMAS PRESENT 2013 RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates JUNIOR PHARMACISTS’ ASSOCIATION – GAMMA CHAPTER
MEMBER
2009 – 2010
PHARMACY DANCE TROUPE MEMBER 2009 – 20102010 – 2011
PRO INTERNAL 2011 – 2012
SCARLET MEMBER 2010 – 2011ACADEMIC ACHIEVEMENTS (Please enumerate) VALEDICTORIANSALUTATORIANBEST IN READINGBEST IN VISUAL ARTSBEST IN COMPUTEROTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
SPECIAL SKILLS
DANCING
PLAYING VOLLEYBALL & BADMINTON
FLIPS(ACROBATICS)To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1
Academic Year 2012-2013 ID
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 4O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
PICTURE
NAME OF ORGANIZATION Pharmacy Dance Troupe
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
TORRES
PATRICIA MONIQUE
LIWANAG
[ ] Male SECRETARY
[ X ] Female
NICKNAME FOR THE ID TRISHA
COURSE & SEC. 3BMT
CONTACT NUMBER / S
RELIGION ROMAN CATHOLIC CITIZENSHIP FILIPINO
Residence #
(045) 982 0769
DATE OF BIRTH 08.29.1993 PLACE OF BIRTH TARLAC, TARLAC Mobile #
0922 882 3874
ADDRESS E-mail Address & FaceBook Account
Home Address DAMA DE NOCHE ST., NINAS VILLE SUBD., TARLAC CITY
E-Mail [email protected]
Provincial Address
DAMA DE NOCHE ST., NINAS VILLE SUBD., TARLAC CITY
Facebook www.facebook.com/trisha.liwanagtorres
FATHER'S NAME LUIS S. TORRES III
MOTHER'S NAMES
ROSARIO FILOMENA L. TORRES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
COLLEGE OF THE HOLY SPIRIT OF TARLAC GRADE 6 2006
SECOND HONORABLE MENTION
Seconday
COLLEGE OF THE HOLY SPIRIT OF TARLAC FOURTH YEAR 2010
FIRST HONORABLE MENTION
College UNIVERSITY OF SANTO TOMAS PRESENT 2014
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates
ACADEMIC ACHIEVEMENTS (Please enumerate)
DEAN’S LIST 1ST SEM- #9 2ND SEM- #11 1ST SEM- #6
AY 2010-2011 AY 2010-2011 AY 2011-2012
OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
JOURNALISM AWARDS
DANCE COMPETITION AWARDS
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 5O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________
SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1
Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION : PHARMACY DANCE TROUPE
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
AJES
KAMILLE NIKKA
ALGENIO
[ ] Male ASST. SECRETARY [ X ] Female
NICKNAME FOR THE ID NIKKA
COURSE & SEC. 3B-PHARMACY
CONTACT NUMBER / S
RELIGION ROMAN CATHOLIC CITIZENSHIP FILIPINO Residence #
DATE OF BIRTH 05-24-1992 PLACE OF BIRTH SAN PABLO CITY, LAGUNA Mobile #
09326729463
ADDRESS E-mail Address & FaceBook Account
Home Address 1217 Juaning St., Sampaloc, Manila
E-Mail [email protected]
Provincial Address 34 San Lucas 1, San Pablo City, Laguna
Facebook www.facebook.com/niksajes
FATHER'S NAME RICARDO A. AJES
MOTHER'S NAMES ALICIA A. AJES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned Year of Graduation Honors Received
Elementary Canossa College, San Pablo City, Laguna 2005
1ST HONORABLE MENTION
Seconday Canossa College, San Pablo City, Laguna 2009
3RD HONORABLE MENTION
College University of Santo Tomas 2013
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 6O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
Name of Organiznce Tration Position Inclusive dates
Pharmacy Dance Troupe Asst. Secretary 2010-2013
Red Cross Member 2012
Clinical Pharmacy Association Member 2012
Junior Pharmacist Association Member 2009-2012
ACADEMIC ACHIEVEMENTS (Please enumerate)
OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
3rd Honorable Mention
Contraternity of Christian Doctrine Silver Awardee
Art Contest, Champion
SPECIAL SKILLS
Dancing
Painting, Drawing
Singing
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________
SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1
Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ________UST Pharmacy Dance Troupe______
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
Pineda
Nathan Enrico
Tongco
[ X ] Male Treasurer [ ] Female
NICKNAME FOR THE ID Nathan
COURSE & SEC. 3F Med Tech
CONTACT NUMBER / S
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 7O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
RELIGION Catholic CITIZENSHIP Filipino Residence # 7349879
DATE OF BIRTH 04 - 24 – 1991 PLACE OF BIRTH Manila Mobile # 09228458031
ADDRESS E-mail Address & FaceBook Account
Home Address 360 Matienza Street San Miguel Manila
E-Mail [email protected] m
Provincial Address
Facebook fb.com/natepineda24
FATHER'S NAME Alfredo Pineda MOTHER'S NAMES
Ma. Theresa Pineda
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary Saint Jude Catholic School Grade 6 SY 2005 Top 15
Seconday
Saint Jude Catholic School 4th year
SY 2009
College University of Santo Tomas 3rd year
SY 2013
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates
SJCS Dance Troupe President 2008-2009
UST Pharmacy Dance Troupe Treasurer 2011-2012
UST Pharmacy Dance Troupe Treasurer 2012-2013
ACADEMIC ACHIEVEMENTS (Please enumerate)
Mathematics Trainers' Guild member (2002-2007), MTG in-house training qualifier, finalist; MTG National Top 50 Algebra performers
OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
District Champions, SJCS Volleyball Team, Cheering Squad Champions (2006-2007), Cheering Squad 1st runner-up (2007-2008),
Tiong Lian Cheering Competition Champions (2008-2009), Outstanding Leadership Award
SPECIAL SKILLS
Music, Arts, Sports
To the best of my knowledge, the above facts as stated are true and correct.OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 8O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
___________________________________________
SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1
Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ______________________________________
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
VALENCIA
GENE PAOLO
SUBANG
[ X ] Male AUDITOR [ ] Female
NICKNAME FOR THE ID PAOLO
COURSE & SEC. 3B-Pharmacy
CONTACT NUMBER / S
RELIGION ROMAN CATHOLIC CITIZENSHIP Filipino Residence #
DATE OF BIRTH 07-03-1993 PLACE OF BIRTH General Santos City Mobile #
09173107459
ADDRESS E-mail Address & FaceBook Account
Home Address Unit 2b, 1145 P. Noval St., Sampaloc, Manila
E-Mail [email protected]
Provincial Address
39 Toledo Subdivision, General Santos City
Facebook [email protected]
FATHER'S NAME Gerard Paul C. Valencia MOTHER'S NAMES
Cecile S. Valencia
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned Year of Graduation Honors Received
Elementary General Santos Hope Christian School Grade 6 2006
Seconday
General Santos Hope Christian School
4th Year High School 2010
College University of Santo Tomas
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates
Project Pax member 2012-present
ACADEMIC ACHIEVEMENTS (Please enumerate)
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 9O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
1st place- Physics Hands-On, (2010), Mananayaw ng Taon 2010, Consistent top 10 award- Chinese instruction, Community Service recognition Award
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________
SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION : Pharmacy Dance Troupe
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG Benigno
AngelouhDjannarah
Pamintuan
[ ] Male External PRO [ x ] Female
NICKNAME FOR THE ID Djann
COURSE & SEC. (incoming) 2B-Pharmacy
CONTACT NUMBER / S
RELIGION Catholic CITIZENSHIP Filipino Residence # 3677633
DATE OF BIRTH 01-04-94 PLACE OF BIRTH Manila Mobile # 09161348954/ 09238706077
ADDRESS c E-mail Address & FaceBook Account
Home Address 76 A West 2nd Avenue Grace Park, Caloocan City
E-Mail [email protected]
Provincial Address
Facebook http://www.facebook.com/angelouh.likes.turtles
FATHER'S NAME Efren C. Benigno MOTHER'S NAMES Daisy P. Benigno
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary University of Santo Tomas, Manila 2007 Honorable Mention
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 10O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
Seconday
St. Scholastica’s College, Manila 2011
College University of Santo Tomas, Manila
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive datesSSC Dance Troupe Senior member 2007-2009 Magnificat Vice President 2010- 2011 Gawad Kalinga Volunteer/member – St. Scholastica’s College 2010-2011ACADEMIC ACHIEVEMENTS (Please enumerate) Consistent top student in elementary Consistent merit awardee in High School OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
3rd place – Math Quiz bee, 2009
Service award – Magnificat Club, 2010
Semi-finalist – Inter-class debate, 2010
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ______________________________________
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
[ ] Male [ ] Female
NICKNAME FOR THE ID
COURSE & SEC.
CONTACT NUMBER / S
RELIGION CITIZENSHIP Residence #
DATE OF BIRTH mm - dd - yyyy PLACE OF BIRTH Mobile #
ADDRESS E-mail Address & FaceBook Account
Home Address
Provincial Address
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 11O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
FATHER'S NAME MOTHER'S NAMES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
Seconday
College
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates ACADEMIC ACHIEVEMENTS (Please enumerate) OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ______________________________________
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
[ ] Male [ ] Female
NICKNAME FOR THE ID
COURSE & SEC.
CONTACT NUMBER / S
RELIGION CITIZENSHIP Residence #
DATE OF BIRTH mm - dd - yyyy PLACE OF BIRTH Mobile #
ADDRESS E-mail Address & FaceBook Account
Home Address
Provincial Address
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 12O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
FATHER'S NAME MOTHER'S NAMES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
Seconday
College
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates ACADEMIC ACHIEVEMENTS (Please enumerate) OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ______________________________________
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
[ ] Male [ ] Female
NICKNAME FOR THE ID
COURSE & SEC.
CONTACT NUMBER / S
RELIGION CITIZENSHIP Residence #
DATE OF BIRTH mm - dd - yyyy PLACE OF BIRTH Mobile #
ADDRESS E-mail Address & FaceBook Account
Home Address
Provincial Address Facebook
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 13O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
FATHER'S NAME MOTHER'S NAMES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
Seconday
College
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates ACADEMIC ACHIEVEMENTS (Please enumerate) OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ______________________________________
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
[ ] Male [ ] Female
NICKNAME FOR THE ID
COURSE & SEC.
CONTACT NUMBER / S
RELIGION CITIZENSHIP Residence #
DATE OF BIRTH mm - dd - yyyy PLACE OF BIRTH Mobile #
ADDRESS E-mail Address & FaceBook Account
Home Address
Provincial Address Facebook
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 14O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
FATHER'S NAME MOTHER'S NAMES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
Seconday
College
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates ACADEMIC ACHIEVEMENTS (Please enumerate) OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ______________________________________
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
[ ] Male [ ] Female
NICKNAME FOR THE ID
COURSE & SEC.
CONTACT NUMBER / S
RELIGION CITIZENSHIP Residence #
DATE OF BIRTH mm - dd - yyyy PLACE OF BIRTH Mobile #
ADDRESS E-mail Address & FaceBook Account
Home Address
Provincial Address
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 15O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
FATHER'S NAME MOTHER'S NAMES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
Seconday
College
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates ACADEMIC ACHIEVEMENTS (Please enumerate) OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ______________________________________
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
[ ] Male [ ] Female
NICKNAME FOR THE ID
COURSE & SEC.
CONTACT NUMBER / S
RELIGION CITIZENSHIP Residence #
DATE OF BIRTH mm - dd - yyyy PLACE OF BIRTH Mobile #
ADDRESS E-mail Address & FaceBook Account
Home Address
Provincial Address Facebook
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 16O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
FATHER'S NAME MOTHER'S NAMES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
Seconday
College
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates ACADEMIC ACHIEVEMENTS (Please enumerate) OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ______________________________________
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
[ ] Male [ ] Female
NICKNAME FOR THE ID
COURSE & SEC.
CONTACT NUMBER / S
RELIGION CITIZENSHIP Residence #
DATE OF BIRTH mm - dd - yyyy PLACE OF BIRTH Mobile #
ADDRESS E-mail Address & FaceBook Account
Home Address
Provincial Address Facebook
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 17O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
FATHER'S NAME MOTHER'S NAMES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
Seconday
College
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates ACADEMIC ACHIEVEMENTS (Please enumerate) OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
ORGANIZATION OFFICER'S INFORMATION SHEET 1x1Academic Year 2012-2013 ID
PICTURE
NAME OF ORGANIZATION ______________________________________
SURNAME FIRST NAME MIDDLE NAME SEX POSITION IN THE ORG
[ ] Male [ ] Female
NICKNAME FOR THE ID
COURSE & SEC.
CONTACT NUMBER / S
RELIGION CITIZENSHIP Residence #
DATE OF BIRTH mm - dd - yyyy PLACE OF BIRTH Mobile #
ADDRESS E-mail Address & FaceBook Account
Home Address
Provincial Address Facebook
OR:08-00-FO20
S t u d e n t O r g a n i z a t i o n s R e c o g n i t i o n R e q u i r e m e n t s
A n n e x A - 18O r g a n i z a t i o n O f f i c e r ’ s I n f o r m a t i o n S h e e t
FATHER'S NAME MOTHER'S NAMES
EDUCATION
Educational Attainment Name and Location of Institution Degree Earned
Year of Graduation Honors Received
Elementary
Seconday
College
Special Training
RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University)
Name of Organization Position Inclusive dates ACADEMIC ACHIEVEMENTS (Please enumerate) OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)
SPECIAL SKILLS
To the best of my knowledge, the above facts as stated are true and correct.
___________________________________________SIGNATURE
OR:08-00-FO20