ANNEX A

R&R FROM 1 (Nomination Form)

RO7 PASIDUNGOG SEARCH

Passport Size
Individual Category: Most Outstanding School Head (Secondary)
Nominee (First Name, Middle Initial, Last Name): Signature:
LLOYD Q. CABCABAN
Position (per Service Record): MOBILE TEACHER Gender: Male Age:
27
Status of Appointment (per Service Record): Date of Birth: April 16,1994
Regular/permanent
Telephone/Cellphone Nos (Active Contact Details): Place of Birth: Tanjay City
09352821327
Residence Address: Brgy. Azagra Tanjay City, Negros Oriental
Level of Position:
1st Level 2nd Level 3rd Level Group Category:
(SDS/ASDS)
Teaching Related Non-Teaching Nominee (Name of School/ Name of
SDO): Mandalamon Elementary School,
Teaching
Tanjay City Division

SCHOOL HEAD
Name: LLOYD Q. CABCABAN Position: T-I
Office/Office Address:Sitio Mandalamon Brgy. Sto Niño, Tanjay City, Negros Oriental
Telephone/Cellphone Nos. (Active Contact Details) Email Address:
09606759445 lloyd.cabcaban@deped.gov.ph
DIVISION/AGENCY HEAD
Name: MA. THERESA V. AVANZADO Position: Schools Division Superintendent
Office/Office Address: Tanjay City Division/ Brgy. 9, Opao Tanjay City
Telephone/Cellphone Nos. (035) -415-9360 Email Address:depedtanjaycity@yahoo.com

NOMINATOR
Name: BRENDO B. TORRES Position: Cluster Head
Office: Cluster 7 Office Telephone/Cellphone Nos.
 Office Address: Tanjay City, Negros Oriental Email Address:

Additional Information about the Nominee:

Were you a previous Pasidungog Nominee? Yes No What Year: 2020

_
What Award Category: ALS IMPLEMENTER _

Were you a previous Pasidungog Semi-finalist? Yes No What Year: _

What Award Category: _

Were you a previous Pasidungog Awardee? Yes No What Year: _

What Award Category: _