Baliwag

Polytechnic
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Junior Philippine Institute of

Accountants

JPIA-BTECH Standing Committee

Application Form
Name: ____________________________________________________________________
Last Name
First Name
Middle Name
Address: __________________________________________________________________
Gender: ____________
Birthday: _____________________
Age:________
Course & Year Level (F.Y. 2016-2017): __________________________
Recent Achievement (e.g Consistent Deans List GPA-1.25) ________________
Affiliations (Current & Previous):
Organization
Position
________________________
_________________
________________________
_________________
________________________
_________________

Date
______________________
______________________
______________________

Significant Academic / Non-Academic Achievements:

Title of Contest
Award
________________________
___________________________
________________________
___________________________

Date
______________________
_____________________

Leadership Principle: ___________________________________________________________

Talents / Skills / Capabilities that may contribute to the success of JPIA:
____________________________________________________________________________________
Explain your reasons why you want to join JPIA-BTECH Standing Committee (not more
than 150 words):
________________________________________________________________________________________
________________________________________________________________________________________

I hereby certify that the above information is true and correct to the best of my
knowledge.

________________________
Applicants Signature