Republic of the Philippines

National Capital Region

DIVISION OF CITY SCHOOLS - MANILA
PIO DEL PILAR ELEMENTARY SCHOOL
Pureza St. Sta. Mesa, Manila

Enclosure No.1

APPLICATION FORM FOR RECOGNITION OF STUDENT ORGANIZATION/CLUB

SCHOOL YEAR 2023-2024

______________________
(Date)

________________________
________________________
________________________

ATTENTION: Office of the Supreme Elementary/Secondary Learner Government

Dear Sir/Madame:
In compliance with the Unnumbered DepEd Memorandum dated May 5, 2023, titled “Interim Guidelines of the
Learner Government Program (LGP) for School Year 2023-2024,” (Article VII: Duties and Responsibilities od the
SELG/SSLG, Section 1:11. To recommend to the School Head the granting, renewal, or revocation of registration of clubs
and organizations.) We are submitting for proper action the following organization/club information and requirements
for recognition:

Name of Organization/Club

Nature of Organization/Club
 Organization – with existing Constitution and By-
 Co-Curricular Laws and / or DepEd Order/ Memoranda,
mandated by the Department of Education
 Extra-Curricular  Club – A group of students with designed
purpose and common interest
Application Date: _____________________________ S.Y. ______________________
No. of Members: _____________________________ No. of Officers: _________________

Organization/Club Objectives:

Attached documents:
 List of Officers
 Designation Order of Teacher Adviser duly signed by the School Head
 Annual Plan of Action
 Constitution and By-Laws/ or DepEd Order/Memoranda (if applicable)

__________________________________________________________________________________________________

Republic of the Philippines

 National Capital Region
DIVISION OF CITY SCHOOLS - MANILA
PIO DEL PILAR ELEMENTARY SCHOOL
Pureza St. Sta. Mesa, Manila

Teacher/Adviser Information
Name

Department

E-mail

Contact Number

Co-Teacher/Adviser (if any)

Name

Department

E-mail

Contact Number

We will respect and abide with the Constitution and By-Laws of the Supreme Elementary/Secondary Learner
Government and the school.

Should our application be accepted, we nominate the student leader below to represent us in the School
Coordinating Council, until further notice.

Name

Designation

Grade Level

E-mail

Contact Number

It is understood that this official Recognition is good only for one (1) school year subjected to renewal unless
revoked prior to its expiration.

Very truly yours,

__________________________
Organization President

Noted:

___________________________
Organization/Club Adviser

__________________________________________________________________________________________________

Republic of the Philippines

 National Capital Region
DIVISION OF CITY SCHOOLS - MANILA
PIO DEL PILAR ELEMENTARY SCHOOL
Pureza St. Sta. Mesa, Manila

To be filled out by Authorized personnel ONLY

RECOMMENDATION:

SELG/SSLG President: . Approved: . Disapproved

Descriptive Evaluation/Recommendation (if Applicable)

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

________________________________ _____________________________________
Signature over printed name Signature over printed name
(SELG/SSLG President) (SELG/SSLG Teacher Adviser)

ACTION: . Approved .Disapproved

Descriptive Evaluated/Recommendation (if applicable)

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

MERIAM B. COLLANTES, Ed.D

(School Head)

Date: ____________________

__________________________________________________________________________________________________