SAINT LOUIS UNIVERSITY

SUPREME STUDENT COUNCIL (SSC)

COMMISSION ON ELECTIONS
Student Center Room 07B, Andres Bonifacio, Baguio City

APPLICATION AND MEMBERSHIP FORM

Term: [ ] 1st Semester [ ] 2nd Semester ; School Year 20

-20___

PERSONAL INFORMATION
POSITION DESIRED:
Name (Last, Given, Middle)

2X2 RECENT

_______________________________________________________________

School: _____________________________________ Gender: _________________________________________

Course and Year: __________________________ Student ID Number: ___________________________
City Address: ___________________________________________________________________________________
Home Address: _________________________________________________________________________________

PHOTO MUST BE
DECENT, FORMAL AND
BE TAKEN OVER A
Write your name at the back
the picture and STAPLE
both this

Date of Birth: ________________________________ Place of Birth: __________________________________

Contact Number: ____________________________ Email Address: _________________________
Do you have any Political Affiliation/s?
Are you an officer of student organization/s?

Control No. ____________

[ ] Yes [ ] No If Yes, Please identify: _____________________________

[ ] Yes [ ] No If Yes, Please identify: _____________________________

I hereby certify to the correctness and truthfulness of the information stated above to the best of my knowledge. Should
I declare any untruthful statement/s or any culpable misrepresentation/s on the information specified above, the
Commission on Elections reserves the right to repudiate and/or invalidate my application.
_______________________________________
SIGNATURE OVER PRINTED NAME
*Please attach a PHOTOCOPY of your PRESENT Official Student Schedule with this form.
If LOST, please secure a DUPLICATE copy from the MIS Office.

(DO NOT FILL UP BEYOND THIS POINT)

REQUIREMENTS SUBMITTED
[ ]
[ ]
[ ]

Application and Membership Form

2 pieces 2x2 Picture
Copy of Student Schedule for Present Term

Date Received by COMELEC:

Remarks:

________________________________
COMMISIONER, Commissions on Elections

APPROVAL AND APPOINTMENT IN THE COMMISSION ON ELECTIONS

I hereby approve the application of _____________________________________________________ as an official member of the
Commission on Elections for the ___________ KASAMA/SSC General Elections working under the following specifications:
POSITION:

[ ] Election Supervisor/BEI Chairman

Precinct No.___________ School: ___________________________

[ ] BEI Member

Precinct No.___________ School: ___________________________

[ ] BEI Marshall

Precinct No.___________ School: ___________________________

[ ] Others (please specify): _______________________________________________________________________________

____________________________________
CHAIRMAN, Commissions on Elections