GERRY ROXAS LEADERSHIP AWARD

Email: grfawardees@gerryroxasfoundation.org
Facebook: GerryRoxasLeaders1958
Twitter: GRLAwardees
Instagram: gerryroxasleaders
11/F Aurora Tower, Araneta Center, Quezon City 1109
Tel. Nos.: 4214006; ext. 119 or 113 ; Fax No.: 9130439

www.gerryroxasfoundation.org

SCHOOL PROFILE FORM

School Principal/Offcial Representative must fill out this form and send back to Gerry Roxas Foundation. Submission of this form will enable GRF to include the school on
the database as ACTIVE Partner and receive the Awardee's Medallion Kit. School Profile Form should be updated and submitted YEARLY to remain as ACTIVE GRF Partner
School.

SCHOOL CONTACT INFORMATION

NAME OF SCHOOL:

Main

Annex

FORMER NAME OF SCHOOL (if any):

COMPLETE SCHOOL ADDRESS: *No.

*Street

*Barangay/Municipality

MOBILE NUMBER:

*City/Province

*Region

YEAR FOUNDED:

Landline No.: *Area Code

*No

NAME OF SCHOOL PRINCIPAL:

Fax: *Area Code

*No

E-mail Address:

CONTACT PERSON/S
DIRECT LINE:

MOBILE NO.:

EMAIL ADDRESS:
ALTERNATE CONTACT PERSON:

TELEPHONE NO.:

DESIGNATION:

EMAIL ADDRESS:

CLASSIFICATION

TYPE

MOBILE NO.:

TOTAL HIGH SCHOOL POPULATION:

Public

Urban

Private

Rural

TOTAL NUMBER OF GRADE 10 STUDENTS:

NAME OF 2016 GERRY ROXAS LEADERSHIP AWARDEE:

ADDRESS:

Note: (Medallion Recipient on 2016 Grade 10 Moving-up Ceremony / Graduation)

CONTACT NUMBER:

PREPARED BY:

SIGNATURE
OVER PRINTED NAME
LDP Rev. 02-25-15

The undersigned representing the school hereby agrees to be

Partner with the Leadership Development Program of the
Gerry Roxas Foundation.
DESIGNATION

PRINCIPAL'S SIGNATURE
OVER PRINTED NAME

DATE: