Republic of the Philippines

Laguna State Polytechnic University

Province of Laguna
Santa Cruz Campus

SPECIAL AWARD FORM

Name of the College/ Organization: College of Hospitality Management and Tourism

Program (if applicable): ________________________________________

Name of the Award: Serviceable Award

Description of the Award:

This is given to selected students of the College who have demonstrated excellence in a range of non-
academic fields including community service, volunteerism, and service above self.

Objectives:

1. To recognize the significant and selfless contribution of the students in the college and
community

2. To encourage other students to emulate the same values of the awardees.

Name of the Recipient/s:

1. Rosean Grace D. Mabansay

2. Melchor B. Tatlonghari II
3. Micah Louies B. Morante
4. Raven Kien D. Villafranca

Narrative Overview:
As per recommendation by the College Dean, upon concurrence of the Selection and Screening Committee,
the above names were considered for the above award. Such students rendered services to the College in several
activities such as acting as student assistant without compensation, accreditation, and college week.

Evaluated, approved and signed by the Selection and Screening Committee:

____________________________ _____________________________ _____________________

Faculty Member Program Chair Faculty Member

__________________________
College Dean
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DECISION

This is to certify that the above recipient/s is/are the final recipient/s of this award.

____________________________ _____________________________ ________________________

Faculty Member Program Chair Faculty Member

__________________________
College Dean

Note: This part is a final decision made by the committee above for both single recipient result or result with 2 or more nominees of
the same obtained score. Deadline of submission for this form will be on May ___, 2019.