AY 2010-2011 Nomination Form

OUTSTANDING STUDENTS CIRCLE OF ILOILO
Founded 2004, ‘Because we believe we can make a difference.’

Search for 10 Outstanding Elementary Pupils and
10 Outstanding Secondary School Students of Iloilo for AY 2010-2011

Nomination Form 1
(This form, together with a 2X2 passport picture and other documents pertaining to the nominee’s qualifications, must be clipped inside a long folder and submitted to the Department of Education, Division Office, where the school is under. Private schools can submit their nominations to the Department of Education, Division of Iloilo, Lapaz, Iloilo City. Deadline of submission is January 6, 2011. Folders and the accompanying documents will form part of OSCI files and will not be returned to the nominees/schools.)



Personal Data


Name of Nominee __________________________________

Birthday_______ Sex ___ Contact Nos. __________________

Grade/Year ______ Current AY General Average (1st, 2nd gradings) ______

Third Year / Grade V General Average ____ Email Address ______

Home Address ____________________________________

_______________________________________________

Father’s Name ____________________________________

Father’s Profession _________________________________

Mother’s Name ___________________________________

Mother’s Profession ________________________________

School __________________________________________

Address _________________________________________

_______________________________________________

District _________________________________________

Coach __________________________________________

Designation __________________ Contact No. ___________

Co-curricular Activities

Please list the summary of co-curricular activities, sorted by date, on a separate sheet, showing the name of the activity, sponsoring entity, venue, and date. Attach certified and signed copies of supporting documents pertaining to the awards, commendations, activities attended, positions held, achievements, etc. of the nominee. Attachments must be sorted the same way as the summary. The documents must have dates within the period January 1, 2010 to December 31, 2010. OSCI reserves the right to disregard or reclassify documents; or ask a nominee/school to show the original documents if necessary. Please do not send the original documents.

Total number of pages of attached documents: ____________________.


Certification

This is to certify that the above information and the attached documents are true, correct, and complete. The Outstanding Students Circle of Iloilo (OSCI) will not be held liable for any errors or misdeclaration found on this form and the accompanying documents.

I also understand that the results of the Search as conducted by OSCI are final and binding.





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School/District Head (Signature Over Printed Name)

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Date