Revised as of April 3, 2023

CACR (COACH /ASST.COACH, CHAPERON RECORD)

III - CENTRAL LUZON

Region

BATAAN
Latest 1½ x 1½ picture
Division

SANTOS, CRISANTO V.
SWIMMING EB GRADE III

A. PERSONAL DATA:

Name: RODRIGUEZ PATRICK N.

(Last) (First) (M.I.)
Sex: MALE Mobile Phone Number: 9361761067
Date of Birth: (mm/dd/yy) 10/18/1993 Age: 30 Place of Birth: DINALUPIHAN, BATAAN

School: ST. JEROME EMILIANI SCHOOL OF DINALUPIHAN BATAAN INC. Employee Number:
Current Position: TEACHER Years in Service: 2 YEARS
Address of School: ROOSEVELT DINALUPIHAN BATAAN

Present Address:
In Case of Emergency Please
Contact: NERY RODRIGUEZ Contact Number:

B. Educational Qualifications: Remarks:

Remarks:
Gold, Silve
Course (College/Post Remark
School Year Graduated Credits Earned Awards Received Gold, Silve
Runner-U
Graduate) Gold, S
Runner-U
Bachelor of Elementary Education Bataan Peninsula State University Dinalupihan Campus 2016 120 Dean's Lister Remark
Runner
Gold, S
Runner

C. Sports Training Attended for the last three (3) years

Title of Sports Training Date of Training No. of Hours Conducted by
8 BPSU Main Campus

Division Year-Round Sports Training Program 5/26/2023 8 DepEd Bataan

D. Sports Track Record/Experience

Athletic Meet Attended Inclusive Dates Event Awards Received

Prepared by: Attested by: Verified by:

(Coach /Asst. Coach Signature over Printed Name) (Division Sports Officer Signature over Printed Name) (Division AO/SDS Signature over Printed Name)

Screened by:

Division Meet Regional Meet Palarong Pambansa

(Signature of DSAC over Printed Name) (Signature of RSAC over Printed Name) (Signature of NSAC over Printed Name)

Date: ______________ Date: ______________ Date: ______________

FOR SCHOOL SPORTS (Division, Region, Palarong Pambansa)