Form 1

YMCA RIZAL YOUTH LEADERSHIP TRAINING

INSTITUTE (RYLTI)
BSU Training Center, Bektey Long-long, La Trinidad, Benguet

REGISTRATION FORM

Attach
latest passport
size photo

Type or print clearly. Please return this form to the YMCA of the
Philippines, 350 AJ Villegas Street, P.O. 1992, Manila, Philippines;
Telefax: 632-5280557; E-mail: ymcaphilippines@yahoo.com by April 15,
2014
FAMILY NAME

FIRST NAME

M.I.

NATIONALITY
Gender
Female
Age

Date of Birth

Male

Month/Day/Year
Address
Street
City/Province
Telephone (Country Code/City code/Number)
Fax
E-mail:
Country of Birth
Passport Number (For
Date of Issue
Foreign Participants)

Country

Postal Code

Expiry Date

Field of Study/Course
Check here if married

Religious Affiliation

Civil Status

Parents/Guardian
Father
Mother

Occupation

Address

Guardian
Educational Background
Schools Attended
Elementary

Inclusive Year

Honors Earned

Course Completed

High School
College
Emergency Contact Person
Name _______________________________

Relationship _____________________________

Address

Telephone

Recommending General Secretary ______________________Applicants Signature: ________________________

Signature ______________ YMCA of ____________________
Date: ____________________________

Form 2
EXTRA-CURRICULAR ACTIVITIES AND COMMUNITY INVOLVEMENT
(Use additional sheets if necessary)
Name of Participant _________________________ Province/City ______________________
I. Membership in Organizations:
Name of Organization
Position Held
Inclusive Dates
Scope
(include membership)
(local, national
international)
1. ___________________
________________ ________________
__________________
2. ___________________
________________ ________________
__________________
3. ___________________
________________ ________________
__________________
4. ___________________
________________ ________________
__________________
II. Extra-Curricular Activities:
A. Leadership Training Attended
Title
Sponsoring Agency Type of Involvement Dates
Scope
1. ___________________
________________ ________________ ________
________
2. ___________________
________________ ________________ ________
________
3. ___________________
________________ ________________ ________
________
4. ___________________
________________ ________________ ________
________
B. Student Congress/Assembly/Conferences Attended
Title
Sponsoring Agency Type of Involvement Dates
Scope
1. ___________________
________________ ________________ ________
________
2. ___________________
________________ ________________ ________
________
3. ___________________
________________ ________________ ________
________
4. ___________________
________________ ________________ ________
________
C. YMCA Related Program
Title
Nature of the
Type of Involvement Dates
Scope
Program
1. ___________________
________________ ________________ ________
________
2. ___________________
________________ ________________ ________
________

3. ___________________
________________ ________________
________
4. ___________________
________________ ________________
________
III. Non-academic Honors/Awards/Citations
1. _____________________________________________
2. _____________________________________________
3. _____________________________________________
4. _____________________________________________
IV. Other Information You May Want to Include

________
________

Certified Correct:
_______________________
_
Signature
Form 3
CERTIFICATION FROM THE SENDING YMCA

This is to certify that the following have been chosen to represent the YMCA of
___________________ to the 2014 YMCA - Rizal Youth Leadership Training Institute.

Name of participant

College/University

_____________________________

__________________________________

_____________________________

__________________________________

_____________________________

__________________________________

_____________________________

__________________________________

_________________________________

_________________________________

General Secretary
(Signature over printed name)

Board President
(Signature over printed name)

Date ________________________

Note: Please forward this form to the YMCA of the Philippines duly signed and filled up before
April 15, 2014

FORM 4
CERTIFICATION OF COLLEGE/UNIVERSITY REGISTRAR
I hereby certify that ________________________________________ is a ( ) sophomore
( ) junior ( ) senior student for the school year 2014 2015 and has the following cumulative average for
the last 4 semesters:
Cumulative Average

Semester

School Year

__________________
__________________
__________________
__________________

_____________
_____________
_____________
_____________

___________________
___________________
___________________
___________________

_________________________________
Name of College/University

____________________________________
Name of College/University Registrar

_________________________________
Address

____________________________________
Signature/Date

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
ENDORSEMENT OF COLLEGE/UNIVERSITY HEAD
This is to certify that _______________________________________ is a student leader in our
school and conducted himself/herself in an exemplary manner.
His application is hereby formally endorsed.

________________________________
Signature Over Printed Name

__________________________________
Designation