(Enclosure No.

XX: Screening Form)

SCREENING FORM [Election]

(Note: This Screening Form shall be accomplished by the Screening and Validation Committee.)

Name of Learner: ___________________________________________________________________

Grade Level & Section: __________________________
Position: ________________________________

Directions: Please check the appropriate box to determine the qualifications of

aspiring student leaders for Learner Government Elections.

REMARKS
Description
Yes No
Required Documents
1. Election Application Form
2. Introductory Profile
3. Photocopy of School Form 9
[Learner’s Progress Report Card]
4. Certificate of Good Moral
Qualifications
1. Is the learner enrolled in the current
school year?
2. Has no failing grades in all subject areas?
3. Is of good moral character?
4. Is the grade level of the aspiring candidate
appropriate to the requirement of the
desired elective position? (refer to Enc. 2)

With all the required documents submitted by the aspiring candidate, the Learner
Government COMEA hereby declares him/her _____ QUALIFIED _____ NOT
QUALIFIED to run for the election.

Verified by:

____________________________________________________
Commissioner on Screening and Validation

Date: ___________________