Student

Organizations

Recognition

Requirements

Annex A- 1
Organization Officers Information Sheet

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

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

Student

Organizations

Recognition

Requirements

Annex A- 2
Organization Officers Information Sheet

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION : Pharmacy Dance Troupe SURNAME Go FIRST NAME Aldrin - Byron NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address 1218 Pacific Suites Dapitan cor. Santander St. Sampaloc, Manila 185 Poblacio 2 Gerona,Tarlac Alexander N. Go M.D. MOTHER'S NAMES COURSE & SEC. CITIZENSHIP PLACE OF BIRTH Filipino Tarlac, Tarlac MIDDLE NAME Amascual [ Aldrin Romsn Catholic
01-03-1992

SEX [ x ] Male ] Female

POSITION IN THE ORG Vice President -Internal

CONTACT NUMBER / s Residence # Mobile # 09328429223

E-mail Address & FaceBook Account E-Mail aldrinrongo@gmail.com www.facebook.com/thefight

Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College

Facebook

Catherine Nuyen A. Go M.D.

Name and Location of Institution College of the Holy Spirit / Don Bosco Technical Institute Don Bosco Technical Institute - Tarlac

Degree Earned

Year of Graduation 2004 2008

Honors Received

University of Santo Tomas

Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization DBTI Student Council Position Business Manager 2007-2008 2007-2008 2006-onwards Inclusive dates

Taekwondo Varsity Captain Service Emergency Volunteer Environmental Network Group (7G) Member ACADEMIC 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 OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 3
Organization Officers Information Sheet

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION: Pharmacy Dance Troupe SURNAME LAPID NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Name and Location of Institution SAN NICOLAS LEARNING CENTER WHIZ KID ACADEMY Secondary O.B MONTESSORI CENTER INC. (ANGELES) Degree Earned GRADE 1 GRADE 2 GRADE 6 1ST 4TH YEAR 2005 2009 2013 Inclusive dates 2009 2010 2009 2010 2010 2011 2011 2012 2010 2011 Year of Graduation Honors Received VALEDICTORIAN SALUTATORIAN DANIEL LAPID
1220 CORNER SANTANDER STREET, PACIFIC GRAND TOWER, DAPITAN, SAMPALOC, MANILA STO. NINO, GUAGUA, PAMPANGA

FIRST NAME STEVEN JAIKKO JAIKKO ROMAN CATHOLIC

04 17 - 1992

MIDDLE NAME GOZUM

SEX [ X ] Male [ ] Female

POSITION IN THE ORG INTERNAL VICE PRESIDENT

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

3C - PHARMACY FILIPINO PAMPANGA

CONTACT NUMBER / S Residence # Mobile # 900-2530 09228262417

E-mail Address & FaceBook Account E-Mail Facebook jaikko_na1617@yahoo.com www.facebook.com/jaikko17

MOTHER'S NAMES

BERNADETH LAPID

College UNIVERSITY OF SANTO TOMAS PRESENT RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization JUNIOR PHARMACISTS ASSOCIATION GAMMA CHAPTER PHARMACY DANCE TROUPE Position MEMBER MEMBER PRO INTERNAL SCARLET MEMBER ACADEMIC ACHIEVEMENTS (Please enumerate) VALEDICTORIAN SALUTATORIAN BEST IN READING BEST IN VISUAL ARTS BEST IN COMPUTER OTHER 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 OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 4
Organization Officers Information Sheet

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION Pharmacy Dance Troupe SURNAME TORRES FIRST NAME PATRICIA MONIQUE COURSE & SEC. CITIZENSHIP PLACE OF BIRTH MIDDLE NAME LIWANAG SEX [ ] Male [ X ] Female CONTACT NUMBER / S Residence FILIPINO TARLAC, TARLAC # Mobile # (045) 982 0769 0922 882 3874 trisha.liwanagtorres@yahoo.com POSITION IN THE ORG SECRETARY

NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College

TRISHA ROMAN CATHOLIC

08.29.1993

3BMT

E-mail Address & FaceBook Account

DAMA DE NOCHE ST., NINAS VILLE SUBD., TARLAC CITY DAMA DE NOCHE ST., NINAS VILLE SUBD., TARLAC CITY

E-Mail Facebook

www.facebook.com/trisha.liwanagtorres

LUIS S. TORRES III

MOTHER'S NAMES

ROSARIO FILOMENA L. TORRES

Name and Location of Institution COLLEGE OF THE HOLY SPIRIT OF TARLAC COLLEGE OF THE HOLY SPIRIT OF TARLAC UNIVERSITY OF SANTO TOMAS

Degree Earned GRADE 6 FOURTH YEAR PRESENT

Year of Graduation 2006 2010 2014

Honors Received SECOND HONORABLE MENTION FIRST HONORABLE MENTION

Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates

ACADEMIC ACHIEVEMENTS (Please enumerate) DEANS LIST 1ST SEM- #9 2ND SEM- #11 AY 2010-2011 AY 2010-2011

1ST SEM- #6 AY 2011-2012

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate) JOURNALISM DANCE SPECIAL SKILLS AWARDS COMPETITION AWARDS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 5
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION : PHARMACY DANCE TROUPE SURNAME AJES FIRST NAME KAMILLE NIKKA COURSE & SEC. CITIZENSHIP PLACE OF BIRTH MIDDLE NAME ALGENIO [ X ] Female NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Name and Location of Institution Canossa College, San Pablo City, Laguna Canossa College, San Pablo City, Laguna University of Santo Tomas Degree Earned Year of Graduation 2005 2009 2013 Honors Received
1ST HONORABLE MENTION 3RD HONORABLE MENTION

SEX [ ] Male

POSITION IN THE ORG ASST. SECRETARY

NIKKA ROMAN CATHOLIC 05-24-1992

3B-PHARMACY FILIPINO SAN PABLO CITY, LAGUNA

CONTACT NUMBER / S Residence # 09326729463 Mobile # E-mail Address & FaceBook Account nikkajes@yahoo.com E-Mail Facebook ALICIA A. AJES
www.facebook.com/niksajes

1217 Juaning St., Sampaloc, Manila 34 San Lucas 1, San Pablo City, Laguna RICARDO A. AJES MOTHER'S NAMES

Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organiznce Tration Pharmacy Dance Troupe Asst. Secretary Red Cross Member Clinical Pharmacy Association Member Junior Pharmacist Association Member ACADEMIC ACHIEVEMENTS (Please enumerate) Position 2010-2013 2012 2012 2009-2012 Inclusive dates

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. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 6
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ________UST Pharmacy Dance Troupe______ SURNAME Pineda NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Name and Location of Institution Saint Jude Catholic School Saint Jude Catholic School University of Santo Tomas Degree Earned Grade 6 4th year 3rd year Year of Graduation SY 2005 SY 2009 SY 2013 Honors Received Top 15 Alfredo Pineda MOTHER'S NAMES 360 Matienza Street San Miguel Manila FIRST NAME Nathan Enrico COURSE & SEC. CITIZENSHIP PLACE OF BIRTH MIDDLE NAME Tongco [ Nathan Catholic
04 - 24 1991

SEX [ X ] Male ] Female

POSITION IN THE ORG Treasurer

3F Med Tech Filipino Manila

CONTACT NUMBER / S Residence # Mobile # 7349879 09228458031

E-mail Address & FaceBook Account E-Mail Facebook nathan_pineda@yahoo.co m fb.com/natepineda24

Ma. Theresa Pineda

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

Student

Organizations

Recognition

Requirements

Annex A- 7
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME VALENCIA NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Unit 2b, 1145 P. Noval St., Sampaloc, Manila Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday University of Santo Tomas College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Project Pax Position member 2012-present Inclusive dates Name and Location of Institution General Santos Hope Christian School General Santos Hope Christian School Degree Earned Grade 6 4th Year High School Year of Graduation 2006 2010 Honors Received 39 Toledo Subdivision, General Santos City Gerard Paul C. Valencia MOTHER'S NAMES Facebook WWE_ROCKS_10@yahoo.com Cecile S. Valencia FIRST NAME GENE PAOLO COURSE & SEC. CITIZENSHIP PLACE OF BIRTH MIDDLE NAME SUBANG [ PAOLO ROMAN CATHOLIC
07-03-1993

SEX [ X ] Male ] Female

POSITION IN THE ORG AUDITOR

3B-Pharmacy Filipino General Santos City

CONTACT NUMBER / S Residence # Mobile # 09173107459

E-mail Address & FaceBook Account E-Mail legends10_619@yahoo.com

ACADEMIC ACHIEVEMENTS (Please enumerate)

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.

OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 8
Organization Officers Information Sheet

___________________________________________ SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTU

NAME OF ORGANIZATION : SURNAME Benigno NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College

Pharmacy Dance Troupe FIRST NAME Angelouh Djannarah COURSE & SEC. CITIZENSHIP PLACE OF BIRTH MIDDLE NAME Pamintuan (incoming) 2BPharmacy Filipino Manila SEX [ ] Male External PRO POSITION IN THE ORG

[ x ] Female

Djann Catholic 01-04-94

CONTACT NUMBER / S Residence # Mobile # 3677633

09161348954/ 0923870607

c 76 A West 2nd Avenue Grace Park, Caloocan City

E-mail Address & FaceBook Account E-Mail Facebook

theskyisfalling501@yahoo.com

http://www.facebook.com/

Efren C. Benigno

MOTHER'S NAMES

Daisy P. Benigno

Name and Location of Institution University of Santo Tomas, Manila St. Scholasticas College, Manila University of Santo Tomas, Manila

Degree Earned

Year of Graduation 2007 2011

Honors Rece

Honorable Mentio

Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position SSC Dance Troupe Senior member Magnificat Vice President Gawad Kalinga Volunteer/member St. Scholasticas College ACADEMIC 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 Inclusive dates 2007-2009 2010- 2011 2010-2011

To the best of my knowledge, the above facts as stated are true and correct. OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 9
Organization Officers Information Sheet

___________________________________________ SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

OR:08-00-FO20

Student

Organizations

Recognition

Requirements

A n n e x A - 10
Organization Officers Information Sheet

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate) OR:08-00-FO20

Student

Organizations

Recognition

Requirements

A n n e x A - 11
Organization Officers Information Sheet

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OR:08-00-FO20

Student

Organizations

Recognition

Requirements

A n n e x A - 12
Organization Officers Information Sheet

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

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate) OR:08-00-FO20

Student

Organizations

Recognition

Requirements

A n n e x A - 13
Organization Officers Information Sheet

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

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

OR:08-00-FO20

Student

Organizations

Recognition

Requirements

A n n e x A - 14
Organization Officers Information Sheet

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

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates OR:08-00-FO20 Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

Student

Organizations

Recognition

Requirements

A n n e x A - 15
Organization Officers Information Sheet

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

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) OR:08-00-FO20 Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

Student

Organizations

Recognition

Requirements

A n n e x A - 16
Organization Officers Information Sheet

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

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College OR:08-00-FO20 Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

Student

Organizations

Recognition

Requirements

A n n e x A - 17
Organization Officers Information Sheet

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