STUDENT AFFAIRS OFFICE

DWCL Main Campus, cor Rizal & Fr. Bates Sts., Old Albay, Legazpi City

C
FORM 3. LEADER’S PROFILE (one copy per officer)
Each officer of student organization must submit a leadership profile for record purposes.

PERSONAL DATA (Note that the information written here will be strictly confidential)

Name Nickname
Paste 1 X 1 photo
Last Name First Name Middle preferably with
Name
white background.
Year, Course & Major
Nationality Religion Birth Date Do not staple the
(mm/dd/yyyy) photo
Age Gender Blood Type
Name of Organization Designation

PRESENT MAILING ADDRESS (Please give the address where you are sure to receive our communication)
House #, Street Name Barangay (Village)
Town or City and ZIP Code Province and Region

Mobile Number (Please indicate only one) Email Add (Please indicate only one) Facebook Account

FAMILY DATA
Father Mobile Number Occupation
If OFW, indicate country of work No. of years abroad
Mother Mobile Number Occupation
If OFW, indicate country of work No. of years abroad
Person to be notified in case if emergency Mobile Number
Legal Guardian (if any) Mobile Number Address

MISCELLANEOUS
Talents, Interests, Hobbies
Food Restrictions
Health Concerns
Trainings/Seminars/Workshops you may be interested to attend as a student leader

I HEREBY CERTIFY that the above information is true and correct to the best of my knowledge and belief

___________________________________________
Signature over Printed Name
___________________
DATE SIGNED

(052) 480 1239 dwclinfo@dwc-legazpi.edu www.dwc-legazpi.edu

 STUDENT AFFAIRS OFFICE
DWCL Main Campus, cor Rizal & Fr. Bates Sts., Old Albay, Legazpi City

C
Note: Presidents of student organizations are required to submit an extra piece of “2x2” photo for the Organizational Chart
and a copy of their class schedule.

(052) 480 1239 dwclinfo@dwc-legazpi.edu www.dwc-legazpi.edu