INSTRUCTIONS AND CHECKLIST OF REQUIRED DOCUMENTS

All pages of the OFFICIAL NOMINATION FORM with all applicable

entries filled up, duly signed by the Nominator and Nominee
where required; PLUS any additional sheets, signed by the
Nominator and the Nominee at the left-hand side of each
additional sheet

All SUPPORTING DOCUMENTS showing the

projects/programs engaged in by the Nominee
(photos, certificates, awards, publications, etc.)

A SIGNED ACKNOWLEDGEMENT/AUTHORIZATION FORM

from the Nominee (please see Annex A)
 OFFICIAL NOMINATION FORM

To formally nominate an individual for the Gawad Parangal sa mga Natatanging

Pasigueno, please fill up this form completely for the consideration of the Selection
Committee.

Apart from the basic information on the nominee, this form will also ask for details on
his/her educational and professional backgrounds, affiliations, awards, and works. It is
recommended to allot at least thirty (30) minutes to accomplish this form.

One form per nominee per category. If nominating more than one person or
selecting more than one category, please fill up another form.

Self-nomination is not allowed.

For other questions or clarifications, please email the Secretariat at

GPNP@pasigcity.gov.ph.

CATEGORY OF NOMINATION

Please choose one (1) category where the nominee has had outstanding and
exemplary contributions:

☐ Culture and the Arts - Architecture ☐ Business, Economics,

Entrepreneurship
☐ Culture and the Arts – Literature ☐ Civic Involvement/Volunteerism
☐ Culture and the Arts - Writing ☐ Law
☐ Culture and the Arts - Music ☐ Medicine and Health
☐ Culture and the Arts - Dance ☐ Public Service/Governance
☐ Culture and the Arts - Visual Arts ☐ Science and Technology
☐ Culture and the Arts - Theatre and ☐ Youth Leadership
Dramatic Arts
☐ Culture and the Arts - Film and Television ☐ Education and the Academe
☐ Sports and Sports Development ☐ Environmental Protection
I.PERSONAL INFORMATION OF NOMINEE

Surname of Nominee Click or tap here to enter text.

First Name of Nominee Click or tap here to enter text.

Middle Name of Nominee Click or tap here to enter text.

Nickname/Pen Name of Click or tap here to enter text.

Nominee
If not applicable, please put
N/A.
Complete Residential Address Click or tap here to enter text.
of Nominee
Nominees must be residents of Pasig for
the last five (5) years.
Non-residents may still be nominated if
they are native-born Pasigueños or if
they had previously resided in Pasig for
at least five (5) years.
Total Number of Years of Click or tap here to enter text.
Residence in Pasig
Place of Birth of Nominee Click or tap here to enter text.

Date of Birth of Nominee Click or tap here to enter text.

Contact Number of Nominee Click or tap here to enter text.

Email Address of Nominee Click or tap here to enter text.

Citizenship of Nominee Click or tap here to enter text.

Civil Status of Nominee Click or tap here to enter text.

If Nominee is married: Click or tap here to enter text.

Full Name of Nominee’s
Spouse
 II. EDUCATIONAL BACKGROUND OF NOMINEE

ELEMENTARY
School Attended Click or tap here to enter text.
Year Graduated Click or tap here to enter text.

HIGH SCHOOL
School Attended Click or tap here to enter text.
Year Graduated Click or tap here to enter text.

COLLEGE
School Attended Click or tap here to enter text.
Year Graduated Click or tap here to enter text.
Degree Obtained Click or tap here to enter text.
Please type out the entire degree
name.

POST-GRADUATE STUDIES
This includes master's degrees, law degrees, medical degrees, and doctorate
degrees.
School Attended Click or tap here to enter text.
Year Graduated Click or tap here to enter text.
Degree Obtained Click or tap here to enter text.
Please type out the entire degree
name.

SCHOLARSHIPS/FELLOWSHIPS RECEIVED BY THE NOMINEE

Please add extra rows/sheets if necessary.
Name of Award/Grant Sponsoring Agency/Institution Year Awarded
Click or tap here to enter Click or tap here to enter text. Click or tap here
text. to enter text.
Click or tap here to enter Click or tap here to enter text. Click or tap here
text. to enter text.
Click or tap here to enter Click or tap here to enter text. Click or tap here
text. to enter text.
Click or tap here to enter Click or tap here to enter text. Click or tap here
text. to enter text.
 MAJOR CONFERENCES ATTENDED BY THE NOMINEE
Please add extra rows/sheets if necessary.
Host Organization Location of Date of Nature of
Conference Conference Participation in
Conference
(ex. Resource
person, delegate)
Click or tap here to Click or tap here Click or tap Click or tap here to
enter text. to enter text. here to enter enter text.
text.
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enter text. to enter text. here to enter enter text.
text.
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enter text. to enter text. here to enter enter text.
text.
Click or tap here to Click or tap here Click or tap Click or tap here to
enter text. to enter text. here to enter enter text.
text.

III. ORGANIZATIONAL AFFILIATIONS OF THE NOMINEE

Please add extra rows/sheets if necessary.

Name of Organization Position Held at Period of

Organization Membership/Affiliation
Click or tap here to enter Click or tap here to enter Click or tap here to
text. text. enter text.
Click or tap here to enter Click or tap here to enter Click or tap here to
text. text. enter text.
Click or tap here to enter Click or tap here to enter Click or tap here to
text. text. enter text.
Click or tap here to enter Click or tap here to enter Click or tap here to
text. text. enter text.

IV. PROFESSIONAL BACKGROUND OF NOMINEE

Please add extra rows/sheets if necessary.

Name of Position/Job Period Company Company

Contact
Employer/Company Title Worked Address Number
Click or tap here to enter Click or tap here Click or tap Click or tap here Click or tap
here to enter
text. to enter text. here to enter to enter text. text.
text.
Click or tap here to enter Click or tap here Click or tap Click or tap here Click or tap
here to enter
text. to enter text. here to enter to enter text. text.
text.
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here to enter
text. to enter text. here to enter to enter text. text.
text.
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here to enter
text. to enter text. here to enter to enter text. text.
text.
Name of Business Nature of Business Position Held by Years of
Operation
Business Address Nominee
Click or tap here to enter Click or tap here Click or tap Click or tap here Click or tap
here to enter
text. to enter text. here to enter to enter text. text.
text.
Click or tap here to enter Click or tap here Click or tap Click or tap here Click or tap
here to enter
text. to enter text. here to enter to enter text. text.
text.
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here to enter
text. to enter text. here to enter to enter text. text.
text.
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here to enter
text. to enter text. here to enter to enter text. text.
text.

V. AWARDS RECEIVED BY THE NOMINEE

The Selection Committee may request the Nominee to provide photos of

trophies, medals, plaques, certificates, and other similar items related to the
awards enumerated in this section.

Please add extra rows/sheets if necessary.

Name of Award Awarding Body Date Awarded
Click or tap here to enter text. Click or tap here to enter text. Click or tap
here to enter
 text.
Click or tap here to enter text. Click or tap here to enter text. Click or tap
here to enter
text.
Click or tap here to enter text. Click or tap here to enter text. Click or tap
here to enter
text.
Click or tap here to enter text. Click or tap here to enter text. Click or tap
here to enter
text.

VI. PUBLISHED/PUBLICIZED WORKS OF THE NOMINEE

Please add extra rows/sheets if necessary.

Title of Work Type of Work Publisher/ Date of

(ex. Book, song, Sponsor (if any) Publication/
poem, sculpture, Launch/
article, etc.) Exhibit
Click or tap here to Click or tap here to Click or tap here Click or tap
enter text. enter text. to enter text. here to enter
text.
Click or tap here to Click or tap here to Click or tap here Click or tap
enter text. enter text. to enter text. here to enter
text.
Click or tap here to Click or tap here to Click or tap here Click or tap
enter text. enter text. to enter text. here to enter
text.
Click or tap here to Click or tap here to Click or tap here Click or tap
enter text. enter text. to enter text. here to enter
text.
VII. SHORT PROFILE ON THE NOMINEE

Answers to the questions below will provide the Selection Committee a

better idea of the nominee's contributions and achievements in a specific
category. Please answer concisely.

1. Briefly describe the nominee's exemplary and outstanding contributions to the

chosen category.
Click or tap here to enter text.

2. How does the nominee's achievements benefit his/her community/field and

the City of Pasig?
Click or tap here to enter text.
 3. How does the nominee's achievements foster pride in the Pasigueño identity?
Click or tap here to enter text.

VIII.REFERENCES

Please provide three (3) people who are familiar with the life and achievements
of the nominee and are not related to him/her by consanguinity or affinity. The
Selection Committee may reach out to these individuals for additional
information on the nominee.
Full Name Relation to the Email Address Contact
Nominee Number
Click or tap here to enter Click or tap here Click or tap here Click or tap
text. to enter text. to enter text. here to enter
text.
Click or tap here to enter Click or tap here Click or tap here Click or tap
text. to enter text. to enter text. here to enter
text.
Click or tap here to enter Click or tap here Click or tap here Click or tap
text. to enter text. to enter text. here to enter
text.

IX.DETAILS OF THE NOMINATOR

Full name Click or tap here to enter text.

Company/Organization Click or tap here to enter text.

Email Address Click or tap here to enter text.

Contact Number Click or tap here to enter text.

Signature

X
 ANNEX “A”

NOMINEE’S ACKNOWLEDGEMENT AND AUTHORIZATION

1. I have read the accomplished Official Nomination Form and attest to the truth
of every statement therein, as well as the authenticity of the Supporting
Documents provided herein;

2. I shall promptly provide additional information if requested by the Selection

Committee;
3. I hereby authorize the Selection Committee of the Gawad Parangal sa mga
Natatanging Pasigueño, as well as its Secretariat, to cross check and validate
the truthfulness of any information provided herein with any organization or
agency, whether public or private, as long as no sensitive personal information
is shared; moreover, if further proof of my consent is required, I shall give the
same/not withhold it unreasonably;

4. I shall make myself available should the selection/judging committee request

my presence, physically or online;

5. If I am selected as one of the Gawad Parangal sa mga Natatanging Pasigueño

awardees, I shall attend the awarding ceremonies and press conference/s and
related activities, whether physically or online; and

6. I consent to the use of any information disclosed in Parts II to VII of the Official
Nomination Form, as well as any information that may be gleaned from the
Supporting Documents or references provided, if necessary in promoting the
Gawad Parangal sa mga Natatanging Pasigueño.

__________________________________________
Full Name and Signature of Nominee
Date Signed: