Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

STO. TOMAS BRANCH
Sto. Tomas, Batangas

Graduating Students Organization

SPECIAL AND LEADERSHIP AWARDS

GENERAL GUIDELINES
This form is being used to collect information from students who are qualified for a special or leadership award
to be given by the Polytechnic University of the Philippines – Sto. Tomas. However, all submitted forms are not
yet final and not assured of any award. All submitted applications are subject to verification and screening.
Read and follow the following guidelines to help you with navigating and filling the form.

1. This form is composed of two sub-forms; Special Awards and Recognition Sub-Form, and Leadership
Awards Sub-Form. If you are applying for both, make sure all information needed in the two sub-forms
are supplied.
2. For the Special Awards and Recognition, the following awards will be given:
a. Academic Exemplary Award
Description: Graduating and non-graduating students who represented the University in any local, regional, or national
competitions.
b. Non-Academic Exemplary Award
Description: Graduating and non-graduating students who represented the University in any sports or dance
competitions, artists, and journalists.
c. President Lister or Dean’s Lister Award
Description: Graduating and non-graduating students who achieved a specific General Weighted Average (GWA) set by
the University.
3. Strictly follow the formatting of information as shown in guides.
4. For the Leadership Awards, the following organizations are accepted:
a. Central Student Council
b. Academic Organizations
c. Non-Academic Organizations (includes Cultural Organizations)
d. Accredited and Authorized Organizations outside of the University
5. You are limited to submitting only one (1) application and repetition is strictly prohibited.
6. After filling, thoroughly check the information you’ve provided, afterwards send a copy of this edited
document to gso.pupstb@gmail.com in .pdf format and following this file naming format
SurnameGiven Name_SLA., example BonifacioJuan_SLA. Put SLA Application – (Your Surname)
as the subject.

Special and Leadership Form – 20

 Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
STO. TOMAS BRANCH
Sto. Tomas, Batangas

Graduating Students Organization

SPECIAL AWARDS AND RECOGNITION SUB-FORM

Name Given Name, Middle Initial, Surname (ex. Juan D. Bonifacio)
Program Choose an item.
Year Choose an item.

Sample:

Competition / Event Name Place Date

1. University Academic Quiz Bee: Spelling Champion July 1, 2018
2. Dean’s Lister - AY 2016-2017
Note: Arrange your entries from the most recent position to the oldest.

Competition / Event Name Place Date

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Note: Should number of entries exceeds the allotted space, please copy and paste the same form for continuation.

Special and Leadership Form – 20

 Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
STO. TOMAS BRANCH
Sto. Tomas, Batangas

Graduating Students Organization

LEADERSHIP AWARD SUB-FORM

Name Given Name, Middle Initial, Surname (ex. Juan D. Bonifacio)
Program Choose an item.
Year Choose an item.

Sample:

Name of Organization Position Date of Membership

1. Central Student Council Councilor September 11, 2017 – March 20, 2018
Note: Arrange your entries from the most recent position to the oldest.

Name of Organization Position Date of Membership

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Note: Should number of entries exceeds the allotted space, please copy and paste the same form for continuation.

Special and Leadership Form – 20