APPLICATION FORM

Personal Information Name Position Desired Nickname Course and Year ID Number Gender Contact Number Email Address Birthday Age Mother's Name Father's Name Motto

2 x 2 picture

Latest QPI Occupation Occupation

Organization

Community Involvement Position

Year

Awards/ Recognitions Received Award or Recognition / Giving Body Year

Where values bring balance

Seminars / Trainings / Conferences Attended Name Venue / Year

Skills Profile __ __ __ __ __ __ __ __ Leadership Group Handling Facilitating Consensus Building Planning Communications Decision Making Conflict Resolutions Evaluating Others: __ __ __ __ Human Relations Self-disclosure Feedback Giving Assertion Interpersonal __ __ __ __ __ Special Skills Fine Arts Computer Operations Computer Graphics Music Dancing

*please mark appropriate choices Essay What is leadership for you?

Why can you consider yourself a leader?

What does being part of the XU-JPIA mean to you?

*please answer briefly Where values bring balance