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The PaniqueniansUSA, Inc.

(A California corporation – non-profit & tax- exempt organization under Section 501 (c) (3) of the Internal Revenue Code)

Officers-Board of Directors

Lourdes D. Ubaldo

Tony D. Beltran
Executive Vice President

Zeny M. Beltran
Ed B. De Guzman
J oseph Lavitoria
Carmen A. Palarca
Lina L. Viernes
Regional Vice Presidents

Evelyn M. Fenchuk

Edwin Acorda
Asst. Secretary

Lilia M. Olonan

Mila A. Palarca
Asst. Treasurer

Lita S. Batenga
Romy R. Lagmay

Gil Eliares
Conrad Batenga
Business Manager

Nick T. Sibal

Board of Directors
Generosa D. Alegado
Bruno M. Alonzo, J r.
Pete D. Beltran
Presito D. Beltran
Eleazer P. De Guzman
Tante E. Lamorena
Dante E. Lumaquin
Purita O. Lumaquin
Freddie O. Manalo
Nancy B. Manalo
Manuel B. Olonan
Cesar M. Palarca
Antonio R. Sideco
Linda A. Sideco
Lourdes D. Ubaldo
Rupert P. Ubaldo
Artemio C. Viernes

1701 Carmel Court, Hayward, CA 94541 – 415.867.7553 -


Last Name: __________________________First Name _________________Middle: ______________
Address: ___________________________________________________________________________
Street City State Zip Tel.
Father/Mother/Guardian: ______________________________________________________________

II - SCHOOL INFORMATION (Please attach additional sheet if necessary)

High School: ________________________________ Graduation Date: ____________GPA: _______
Address: __________________________________ City __________________State: ____Zip: ______

Colleges or universities applicant has been accepted or applied and planned major field of study:

Address: ______________________________ City: __________________ State: _____ Zip: ________

III - EXTRA-CURRICULAR ACTIVITIES & AWARDS (Please attach additional sheet if
necessary) List all school activities in which you have participated during the past four years (e.g.
student government, sports, choir, band, drama and dance production).

Description of School Activities, Awards and Honors School Year Months

IV - COMMUNITY INVOLVEMENT (Please attach additional sheet if necessary) List all
community activities in which you have participated during the past four years (e.g. volunteer work)
including activities of the PaniqueniansUSA, Inc. or its sister associations in LA.

Description of Community Activities (include any agency name)


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

Applicant’s Signature_____________________________________________ Date: _______________

Parent’s or Guardian’s Signature: ___________________________________ Date: _______________

This application is considered complete when the applicant returns the signed application with
documentation (high school transcript and or proof of GPA, copy of acceptance letter from a college or
university and photo).

Please mail application to: Lourdes D. Ubaldo, President, PaniqueniansUSA, Inc., 1701 Carmel Court,
Hayward, CA 94541, (415) 867-7553 or