SSLG IMMERSION APPLICATION FORM

The Supreme Secondary Learner Government Program

embodies the ideals, principles, and practices of
participatory democracy. It represents and steers the
learners toward the fulfillment of its goal by promoting their
rights and welfare. As a learner, this Immersion Application
Form is a statement of your best knowledge and
understanding of the position you are applying for.

Instruction: Please supply the information requested in the

space provided.

I. PROFILE
Learner’s Name: __Ercilla , Aeon Flyff, Aldave ____________________________
(Surname, Given Name, Middle Name, & Extension Name)
Grade Level, Section, & Curriculum: 10, Euler, STE____________________________
Position Applied to: _Secretariat Committee__________________________________
Gender: _Male_____________ Age: _15__________ Date of Birth:_10/25/07_____
Email Address: flyffercilla@gmail.com___ Phone Number: 09669788832_______
Home Address: Blk. 20 Lot 15, Castro Avenue, Matatalaib, Tarlac City, Tarlac,

II. PARENTAL CONSENT

I, _Virginita A. Galapon as a parent/ guardian of _Aeon Flyff A. Ercilla will
support his/her commitment to the Supreme Secondary Learner Government to
the best of my ability. I am allowing him/her to participate in the programs,
projects, and activities of the Supreme Secondary Learner Government. I agree
and understand the commitment of my son/daughter and will support his/her
endeavor to the Supreme Secondary Learner Government.
_____________________________________________ ______09958877418______
Name and Signature of the Parent/Guardian Contact Number

III. CERTIFICATION
I am filing this Immersion Application Form of the Supreme Learner
Government for the school year 2023-2024.
I hereby certify that the facts stated herein are true and correct to the
best of my knowledge.

_______________________________________________________
Signature of Candidate over Printed Name
Verified by: Approved by:
________________________________________ _____________________________________
Presiding SSLG Officer SSLG Adviser

Date: __________________ Date: __________________