SEARCH FOR THE OUTSTANDING LUZON CHIEF SQUIRES Personal Data and Contact Details Name Last Name
First Name
Nickname
Age
Middle Name
Birth date
Blood Type
PASTE 2x2 photo with white background here. No cut-outs please.
Present Mailing Address (Please give us the address where you are sure to receive our letter) House #, Street Name
Barangay (or Village)
Town or City and Zip Code
Province and Region
Phone
Mobile Phone Please indicate only one.
Please include NDD area code.
Do not staple!
Email Please indicate only one.
Family Data (Please indicate if deceased or separated.) Father
Occupation
Mother
Occupation
Legal Guardian
Occupation
Brother/s
Sister/s
Education Profile School Attended
Level/Course/Degree
Inclusive Years
Elementary High School College Others
Council and Circle Data Sponsoring Council Number
Sponsoring Council Name
Sponsoring Council Location Circle Number
Circle Name
Circle Location Date of Investiture Squire Advancement Level
Date Achieved
Hobbies and Interests _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
I certify, to the best of my knowledge, that all information presented in this application form are accurate and valid. Any misrepresentation shall automatically disqualify me from the AYLC selection process. ________________________ Signature above Printed Name
___________________ Date Signed
SEARCH FOR THE OUTSTANDING LUZON CHIEF SQUIRES INominee’s Leadership Achievement Profile (Please use additional sheet if necessary) List your circle, school or community-based leadership positions and involvements. List them down in chronological order and spell out acronyms. All listed positions shall be supported by certificates, appointment letters, photos and any supporting document/s.
No. Ex.
Position/Designation Class Representative
Name of Organization Freshmen Council
Inclusive Year
Level
2006-2007
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Nominee’s Social Responsibility Profile
(Please use additional sheet if necessary)
This portion shall include civic engagements and community involvements done voluntarily. This may includes work done independently or in connection with the circles/ council service and social activities or work done with any government/ non government organizations. All listed activities shall be supported by certificates, clippings, photos and any supporting document/s.
S
SEARCH FOR THE OUTSTANDING LUZON CHIEF SQUIRES Nominee’s Awards/ Recognitions Received (Please use additional sheet if necessary) This profile shall include awards or citations given in recognition of achievements or services rendered in the context of academics, co and extra curricular activities, leadership, social activities and community services. All listed awards shall be supported by certificates, clippings, photos and any supporting document/s.
Date (MM-DD-YY)
Rank, Name of Honor/ Award Received
Given By
Description of Honor/ Award Received
Level
Note: For the LEVEL Column, use this legend: I- International; N- National; R- Regional; P- Provincial; M-Municipal/ City; S-School
Most Significant Accomplishment (Please use additional sheet if necessary) From the profiles listed above, choose one (1) most significant accomplishment per category. In not more than 200 words per category, write a narrative explaining the reasons why you consider each significant. Leadership _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Social Responsibility _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
Awards/ Recognitions _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________