Individual Registration Form

Individual Registration Form Page 1 of 2

3rd STUDENT COUNCIL LEADERSHIP CONFERENCE

AN WARAY P

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Changing Ourselves to Change the World: Responding to the Challenge of a Global Ethic Leadership

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Participant’s Registration Form
Please print or type legibly. Accomplish in triplicate. Do not leave any space blank.

PERSONAL DETAILS FIRST NAME MIDDLE NAME LAST NAME PARTICULARS

Age Date of Birth (dd/mm/yyyy) Place of Birth Permanent Home Address Complete Mailing Address Telephone Number Mobile Number Email Address Sex Nationality Religion Father’s Name Mother’s Name

EDUCATIONAL BACKGROUND ELEMENTARY

Address Inclusive Years Honors Received Leadership Position

SECONDARY

Address Inclusive Years Honors Received Leadership Position

COLLEGE Address Years of Residence Current Year Level Academic Course Major Latest G W A

Paste 2x2 photo in proper attire. NO scanned, photocopied or cutout picture. Do NOT staple your photo.

Individual Registration Form Page 2 of 2

CURRENT LEADERSHIP RECORD STUDENT COUNCIL

Title of Current Position Formal Organizational Name Years in Office Nature of Office

 Elected

 Appointed by _______________  Ex Officio

 Elected

 Appointed by _______________  Ex Officio

 Elected

 Appointed by _______________  Ex Officio

Job Description of Office

OTHER ORGANIZATIONS

Title of Current Position Formal Organizational Name Years in Office Nature of Office Job Description of Office

OTHER ORGANIZATIONS

Title of Current Position Formal Organizational Name Years in Office Nature of Office Job Description of Office


Use separate sheet of paper, if necessary

RECOMMENDATION OF SCHOOL HEAD This is to recommend Mr./Ms. ____________________________________________________, of legal age, (Complete Name of Student)

a student of this college/ university, taking up the degree _________________________ on his/her ____________ (College Degree)

(Year Level)

and presently the _________________________ of the _______________________. Furthermore, this is to attest (Leadership Position)

(Organization)

that the aforementioned is of good moral standing in our college/ university. _______________________________________ Signature over Printed Name of the School Head

_______________________________________ Designation/Position

COLLEGE OR UNIVERSITY

Name of School Complete Mailing Address Phone Fax Email I attest upon my honor that all statements made in this form are true and correct.

________________________________ Signature over Printed Name

_______________________ Date Accomplished