ICCAC COMPETITIONS 2023 OFFICIAL ENTRY FORM AND GALLERY OF

March 27-30, 2023 – Southern Luzon State University, Lucban Quezon ________ ARNIS__________________
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INSTITUTION: SOUTHERN LUZON STATE UNIVERSITY -CTE Category

ATHLETE ATHLETE ATHLETE ATHLETE ATHLETE ATHLETE

Recent Scanned Recent Scanned Recent Scanned Recent Scanned

Picture Picture Picture Picture

Name Jaecelle Milan B. Sarmiento Jana Marie Permejo Agarin

Date of Birth March 8, 2001 January 8, 2003
Course & Year BSESS BEED - IIB
School/Campus CTE CTE
COACH ASST. COACH Eligibility Requirements:
ICCAC 2023
1.) Official Transcript of
Records (TOR) with:
a.) complete scholastic
record of athlete University Seal
b.) subjects and grades of 1st
Sem, SY 2021-2022
c. Subjects enrolled for 2nd Sem,
AY 2021-2022
d.) Scanned picture of student
e.) School Dry Seal ________________
2. SCUAA Games Form 1, 2 & 3 SPORTS DIRECTOR
Name Type here Type here 3. PSA/NSO Birth Certificate
4. Vaccination Card
Age Type here Type here 5. Health Insurance
Contact no#/ Mobile no# Type here Type here 6. CMO 63 – Certificate of
compliance from HEI
Email Address Type here Type here