Individual Registration Form

Page 1 of 2

3rd STUDENT COUNCIL LEADERSHIP CONFERENCE

Changing Ourselves to Change the World: Responding to the Challenge of a Global Ethic Leadership
AN WARAY
P A R T Y L I S T

Participant’s Registration Form Paste 2x2 photo

in proper attire.

Please print or type legibly. Accomplish in triplicate. Do not leave any space blank. NO scanned,
photocopied or
cutout picture.
PERSONAL DETAILS Do NOT staple
your photo.
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
 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
Job Description of Office

OTHER Title of Current Position

ORGANIZATIONS
Formal Organizational Name
Years in Office
Nature of Office  Elected  Appointed by _______________  Ex Officio
Job Description of Office

OTHER Title of Current Position

ORGANIZATIONS
Formal Organizational Name
Years in Office
Nature of Office  Elected  Appointed by _______________  Ex Officio
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

Name of School
COLLEGE OR
UNIVERSITY 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