Philippines Society of Information Technology

Educators DFCAMCLP – Chapter

APPLICATION FORM

CHECKLIST OF APPLICATION REQUIREMENTS

___ Fully accomplished application form and copy of official school registration form or certificate of
registration to be emailed to psitedfcamclpit@gmail.com with subject heading: PSITE 2023-2024:
Application (Name of Applicant). Please limit the email to 15 MB and in PDF.
___ In the face to face interview with the previous President and Adviser, please bring a hard copy of your
application form.
___ For more information, kindly message the facebook page here:
https://www.facebook.com/profile.php?id=100084310556409 .

PERSONAL INFORMATION
First Name: Raymond
Anthony Middle Name: Polo Last Name: Agcaoili Suffix

Nickname/Preferred
Name: Raymond Gender/Pronoun: Male

Date of Birth: March 15,

2002 Place of Birth: Las Pinas City Insert 2” x 2” Picture
taken within the last three months

Religion: Catholic Civil Status: Single

Position Acquiring: Auditor

CONTACT INFORMATION

Home Address (House/Bldg. Number, Street, Barangay, Municipality/City, Province)

B11 L4 Hornbill St. East 1 Camella Springville Molino III, Bacoor City, Cavite, 4102

Landline: N/A Mobile Number: 09924091061

Alternate Mobile Number:
09352744456

Personal E-mail Address: DFCAMCLP E-mail Address:

Fax
agcaoiliraymondanthony@gmail.co agcaoili.raymondanthony@
m dfcamclp.edu.ph

PSITE 2023 - 2024; Application Form| Page 1

 Philippines Society of Information Technology
Educators DFCAMCLP – Chapter

EDUCATIONAL BACKGROUND

Degree Finished Year Finished School

Undergraduate

Dr. Filemon C. Aguilar

Bachelor Science in Information Memorial College Las
System 2020-Present Pinas- Satelite

Graduate

Information in Communication Asian Seed Academy of

Technology 2020 Technology

Others

LEADERSHIP PROGRAMS ATTENDED (add more rows if necessary)

Program Name Program Duration Organizer

AFFILIATIONS AND NETWORKS

Name of Affiliation/Network Designation Inclusive Dates

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 Philippines Society of Information Technology
Educators DFCAMCLP – Chapter

SOCIAL MEDIA HANDLES

LinkedIn URL (Put NA if not Twitter Handle (Put NA if not

applicable): applicable):
Your Facebook Account URL (Put
NA if not applicable):

Instagram Handle (Put NA if not Tiktok Handle (Put NA if not Kumu Handle (Put NA if not
applicable): applicable): applicable):

ESSAY

Instructions: Answer all the questions below in essay form. Answers to each item must not exceed
250 words.
What other leadership roles have you taken in the past? What results have you generated? Cite specific
examples.

Statement of Agreement
I certify that my answers are true and complete to the best of my knowledge.
I hereby declare that I am willing and able to assume the responsibilities expected from all aspiring Fellows,
including participation in every event of the academic organization. By submitting this form, I am giving
Philippines Society of Information Technology Educators DFCAMCLP - Chapter (PSITE DFCAMCLP - Chapter) the
consent to collect, generate, use, process, store and retain my personal data.

Signature over printed

name: RAYMOND ANTHONY P. AGCAOILI Date: AUGUST 18, 2023

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