Student

Organizations

Recognition

Requirements

Annex A- 1
Organization Officers Information Sheet

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ SIGNATURE OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 2
Organization Officers Information Sheet

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ SIGNATURE OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 3
Organization Officers Information Sheet

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013 NAME OF ORGANIZATION _____ROTARACT CLUB UST AMV COA UNIT_____ SURNAME DEL ROSARIO FIRST NAME GIO CELINO MIDDLE NAME NAVARRO SEX [ X ] Male [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Name and Location of Institution CHRIST THE KINE COLLEGE, LA UNION CHRIST THE KING COLLEGE, LA UNION UNIVERSITY OF SANTO TOMAS, MANILA Degree Earned DIPLOMA DIPLOMA Year of Graduation 2005 2009 1256 T. SAN LUIS STREET, PANDACAN, MANILA 314 SEVILLA NORTE, QUEZON AVENUE, SAN FERNANDO CITY, LA UNION CHARLIE APOLINARIO A. DEL ROSARIO MOTHER'S NAMES GIO ROMAN CATHOLIC
10-03-1992

1x1 ID PICTURE

POSITION IN THE ORG VICE PRESIDENTEXTERNAL

] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

ACCOUNTANCY, 3A2 FILIPINO TARLAC CITY

CONTACT NUMBER / S Residence # Mobile # (02) 354 1771 09156980151

E-mail Address & FaceBook Account E-Mail Facebook gio_celino2@rocketmail.com www.facebook.com/giocelino

MARIE FEL G. NAVARRO DEL ROSARIO

Honors Received OUTSTANDING OUTSTANDING

Special Training N/A RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position ROTARACT CLUB AMV UNIT PROTEGE ACCOUNTANCY JOURNAL TRAINEE BUKAL PUBLICATION ORG ASSOCIATE EDITOR TIMEK PUBLIC SPEAKING ORG FACILITATOR ACADEMIC ACHIEVEMENTS (Please enumerate) Inclusive dates 2011-2012 2009-2010 2008-2009 2008-2009

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate) CIP AWARD FOR JOURNALISM CIP AWARD FOR PUBLIC SPEAKING LOYALTY AWARD SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ SIGNATURE

OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 4
Organization Officers Information Sheet

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE Asst secretary

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Name and Location of Institution Degree Earned Year of Graduation MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

Honors Received

Inclusive dates

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 5
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 6
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 7
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 8
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

Annex A- 9
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

A n n e x A - 10
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

A n n e x A - 11
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

A n n e x A - 12
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

A n n e x A - 13
Organization Officers Information Sheet

SIGNATURE

ORGANIZATION OFFICER'S INFORMATION SHEET

Academic Year 2012-2013

1x1 ID PICTURE

NAME OF ORGANIZATION ______________________________________ SURNAME FIRST NAME MIDDLE NAME SEX [ [ NICKNAME FOR THE ID RELIGION DATE OF BIRTH ADDRESS Home Address Provincial Address FATHER'S NAME EDUCATION Educational Attainment Elementary Seconday College Special Training RECORD OF EXTRA-CURRICULAR ACTIVITIES (Inside and Outside of the University) Name of Organization Position Inclusive dates Name and Location of Institution Degree Earned Year of Graduation Honors Received MOTHER'S NAMES
mm - dd - yyyy

POSITION IN THE ORG ] Male ] Female

COURSE & SEC. CITIZENSHIP PLACE OF BIRTH

CONTACT NUMBER / S Residence # Mobile # E-mail Address & FaceBook Account E-Mail Facebook

ACADEMIC ACHIEVEMENTS (Please enumerate)

OTHER AWARDS RECEIVED IN HIGH SCHOOL AND COLLEGE (Please enumerate)

SPECIAL SKILLS

To the best of my knowledge, the above facts as stated are true and correct. ___________________________________________ OR:08-00-FO20

Student

Organizations

Recognition

Requirements

A n n e x A - 14
Organization Officers Information Sheet

SIGNATURE

OR:08-00-FO20