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11 Batang Capiznon Awards

Search for the Ten Outstanding Students of Capiz (TOSOC) 2023

APPLICATION FORM – SECONDARY CATEGORY

PLEASE FILL OUT THE FORM LEGIBLY. (Revised Form February 24, 2023) NOT FOR SALE – MAY BE REPRODUCED

1. Surname: LEONIDA 2. Gender: [ M ] [ F ] Passport-sized photo

First Name: JAMES ANDREI________________________________ 3. Height: _5’5______________ _______________________

Middle Name: LAJO______________________________________4. Weight: _45_____________ Date taken:______________

Nickname: JIM JIM_____________________________ 5. Birthdate: _APRIL 30, 2005____________

6. Birthplace: MAMBUSAO DISTRICT HOSPITAL __________7. T- Shirt Size: MEDIUM____________.

8. Residence/Mailing Address: _BALIT, MAMBUSAO CAPIZ__________________________________

9. Email Address: __jamesandreileonida3@gmail.com___________________________ ___________________________

10. Mobile No.: _09702808041__________________________________11. Religion: _CATHOLIC_

12. School : _DAVID MOISES MEMORIAL HIGH SCOOL__13. Address: _Balit Mambusao, Capiz_

11. Health/Food Restrictions: NONE

14. Emergency Contact Name: ROQUE E. LEONIDA Relationship: FATHER

Address: BALIT MAMBUSAO, CAPIZ Contact No.: 09093310094

15. Father’s Name ROQUE E. LEONIDA Occupation: ELECTRONIC TECHNICIAN

16. Mother’s Name ANATOLIA L. LEONIDA Occupation: HOUSEWIFE

17. Educational Background Name of School/University Inclusive Dates Highest Academic Honors Received

Elementary BALIT ELEMENTARY SCHOOL APRIL 2017 VALEDICTORIAN

18. ACADEMIC PERFORMANCE

A. GWA/GPA (Grade 7 to Grade 11)

st nd
B. ACADEMINC HONORS (1 Honors, 2 Honors, etc. or with highest honors, with high honors, with honors)
st nd
Grade Honors (1 Honors, 2 Honors, etc. or with highest honors, with high honors, with Supporting Document Attached Page Number of the Supporting Document
honors)

7 WITH HONORS CERTIFICATE

8 WITH HONORS CERTIFICATE

9 WITH HONORS CERTIFICATE

10 WITH HONORS CERTIFICATE

11 WITH HIGH HONORS CERTIFICATE

19. CO- AND EXTRA-CURRICULAR ACTIVITIES

A. Leadership Positions (use extra sheets (8.5”x13’’) if necessary, using the same format)
Position Name of Organization/Office Level Supporting Document Attached Page Number of the Supporting

(International, national, regional, division/provincial, district/city/municipal (certificates/photos/ newspaper Document

and school) clippings, etc.)

1. GRADE 7 REPRESENTATIVES SUPREME STUDENT GOVERNMENT SCHOOL CERTIFICATES

2. GRADE 7 VICE PRESIDENT ENGLISH CLUB SCHOOL CERTIFICATES

3. GRADE 7 AUDITOR FILIPINO CLUB SCHOOL CERTIFICATES

B. Seminars/Trainings (use extra sheets (8.5”x13’’) if necessary, using the same format)
Title of the Seminar/Trainings Date & Venue Conducted by: Level Supporting Document Attached Page Number of the Supporting

Document

1.JOURNALISM SEMINAR AUGUST 4-5 2018, ROBINSONS JUDE THADDEUS I. ILEDAN, DIVISION CERTIFICATE

PLACE, ROXAS CITY PH. D.

2.JOURNALISM SEMINAR AUGUST 1O-11 2019, ROBINSONS JUDE THADDEUS I. ILEDAN, DIVISION CERTIFICATE

PLACE, ROXAS CITY PH. D.

3.CAMPUS JOURNALISM SEMINAR SEPTEMBER 7 2018 ATTY. MA. JANET C. MESA, REGIONAL CERTIFICATE

PH.D.

C. Non-Academic Awards & Recognitions Received (use extra sheets (8.5”x13’’) if necessary, using the same format)
Name/Title of the Award Date Given Award Giving Body Level Supporting Document Attached Page Number of the Supporting

Document

1. CERTIFICATE

2. CERTIFICATE

3. CERTIFICATE

20. COMMUNITY INVOLVEMENT [use extra sheets (8.5”x13’’) if necessary, using the same format]
Title of the Activity Venue Date Level Supporting Document Attached Page Number of the Supporting

Document

1. ADOPT A RIVER CERTIFICATE

2. TREE PLANTING PROGRAM OF YES-O CERTIFICATE

3.FEEDING PROGRAM CERTIFICATE

4. CERTIFICATE

5.

21. Special Skills or Talent

22. Character References (not related within the third degree of consanguinity or affinity)

Name Occupation/Designation Name of Office and Address Tel./Mobile No.

1.Luzviminda A. Labao Municipal Mayor

2.

3.

23. How did you know about the program?

Newspaper: _____ Radio: ______ Magazine: _____ Internet: ______ Others [pls. Indicate]: _____________________

24. Have you ever been convicted of any crime involving moral turpitude? [ ] No [ ] Yes

If yes, please indicate the nature and status. ___________________________________________________________

25. Do you have any pending case? [ ] No [ ] Yes

If yes, please indicate the nature and status. ___________________________________________________________

All facts and data given in this application form will be treated with utmost confidentiality.
 SWORN STATEMENT
I hereby certify upon my honor that all facts and information indicated herein are true and correct to the best of my knowledge. I likewise declare that any false information given or stated may constitute a
ground for disqualification for the Batang Capiznon Award – a search for the Ten Outstanding Students of Capiz. Moreover, I hereby commit myself to participate in all TOSOC activities including the post-TOSOC
implementation of batch advocacy plan. Further, I willingly and wittingly commit myself to be a BYLI volunteer/member and comply with post-TOSOC and BYLI programs/activities as part of the advocacy for nation-
building.
Lastly, I subscribe and agree that the Borres Youth Leadership Institute (BYLI), Inc. has the sole prerogative to select the finalist for the Batang Capiznon Award – a search for the Ten Outstanding Students of Capiz
and its decision is final and executory.
IN WITNESS hereof, I am executing and signing this statement voluntarily without compulsion.
________JAMES ANDREI L. LEONIDA_________
Name & Signature of Applicant/Nominee
________ROQUE E. LEONIDA_________
Name & Signature of Parent/Guardian

Doc. No.: ________;

Page No.: _______; _________________________________
Book No.: _______; NOTARY PUBLIC
Series of 2023.

NO. QUALIFICATION DOCUMENTARY REQUIREMENTS

1 A Filipino citizen; ● (must be stated in the Notarized Application Form

- 1 original & 2 photocopies)

2 A bona fide graduating senior high school (Grade 12) or college student for academic year 2022-2023 ● (must be stated in the Letter of Nomination - 1 original copy)

3 Nominated by the school, college, or university; ● Letter of Nomination from the School Head/ Principal/ Dean/Director of Student Affairs (1 original copy)

4 Resident of the Province of Capiz; ● Certificate of Residency from the Punong Barangay
(1 original copy)

5 Has not been subjected to any disciplinary action or obtained derogatory record. ● Good moral character issued by the schoolguidance counselor/ principal/dean/school head (1 original copy)

6 Must be available and willing to participate in all TOSOC activities; and commit to the post-TOSOC implementation of advocacy ● (must be stated/declared in the Notarized Application Form)
plan.

7 Must be willing to be a BYLI volunteer/member and comply with post-TOSOC programs/ activities. ● (must be stated/declared in the Notarized Application Form)

8 Has an outstanding academic record and must not have obtained any DROPPED or FAILING GRADE. Any INC must have a ● Certified True Copies of Scholastic Records/Transcript of Records/ Copy of Grades/Form 137/SF 10 (1 original copy)

completion grade; and ● Certificate indicating the GWA/GPA (1 original copy)

● Certificate stating the highest honor received in a given quarter/semester/school year (1 original copy)
See details in the next page.

9 An outstanding student in co- curricular and extra-curricular activities (non-academic awards, attendance in seminars/trainings & ● LIST OF CO- AND EXTRA- CURRICULAR ACTIVITIES
positions held in organizations); a. Non-academic recognition and awards

10 Involved in community service activities; b. Seminars and Trainings

c. Leadership Positions
● LIST OF COMMUNITY OUTREACH PROGRAMS, PROJECTS, AND ACTIVITIES
(All must be stated in the NOTARIZED APPLICATION FORM with supporting documents)

NOTE: PLEASE GET A COPY OF THE INVITATION KIT FOR THE COMPLETE DETAILS OF DOCUMENTARY REQUIREMENTS AND LIST OF

SUPPORTING DOCUMENTS.
DATE ACTIVITY

nd
April 14, 2023, 5:00 P.M. Deadline of submission of all nominations at BYLI Roxas Office at Unit 1, 2 Floor, EAS Building II, Magallanes Street, Roxas City.

NOTE: 1 point shall be deducted from the total score for every 15 minutes late.

April 15 – 26, 2023 Screening and Notification of Nominees

May 7, 2023 Radio Interview, Photo and Video Shoot of TOSOC 2023 Finalists (Secondary Category)

May 14, 2023 Radio Interview, Photo and Video Shoot of TOSOC 2023 Finalists

(Tertiary Category)

May 27, 2023 Advocacy Session

June 1 - 5, 2023 Pag-ulopdanay (a stay-in leadership & team building formation for the finalists).

Venue: TBA

June 2, 2023 | 1:30 PM External Panel Interview

June 3, 2023 | 7:00 AM TOSOC Outreach Activity

June 3, 2023 | 3:00 PM TOSOC Alumni Interaction

June 4, 2023 l 1:00 PM Awarding Ceremony Venue: TBA

SCHEDULE OF ACTIVITIES