Department of Education

DIVISION OF TANAUAN CITY

SEARCH FOR OUTSTANDING YOUNG LEADERS

NOMINATION FORM

Please write legibly. Mark appropriate boxes with “ / “ and use separate sheet if necessary.

Choose one: Elementary Secondary

Category: Individual Group

Name of School : BOOT NATIONAL HIGHSCHOOL SUPREME STUDENT GOVERNMENT

SSG/SPG Position : ______________________________________________________

PERSONAL INFORMATION

Surname : ________________________________________________________________________

First Name : ___________________________________ Nickname : __________________________

Middle Name : _____________________________________________________________________

Date of Birth : _______________________ Residential Address : _____________________________

Place of Birth : ______________________________________________________________________

Sex: Male Female Tel. No. : __________________ Cell No. : __________________

Citizenship : __________________ Religion : ___________________ Email : ____________________

ONE DIVISION, ONE HEART

Department of Education
DIVISION OF TANAUAN CITY
EDUCATIONAL BACKGROUND

Level Name of School & Address Gen. Ave. Inclusive dates

Elementary : ____________________________________________ ________ _______________

Secondary : ____________________________________________ ________ _______________

ACADEMIC HONORS / AWARDS RECEIVED (Start from most recent)

Name of Award Awarding Body Inclusive Dates

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

NON-ACADEMIC HONORS / AWARDS RECEIVED (Start from most recent)

Name of Award Awarding Body Inclusive Dates

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

ONE DIVISION, ONE HEART

Department of Education
DIVISION OF TANAUAN CITY
EXTRA-CURRICULAR AND CO-CURRICULAR ACTIVITIES (Start from most recent)

Position / Title Organization’s Name Inclusive Dates

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

TRAINING PROGRAMS ATTENDED (Start from most recent)

Title of Seminar/ Conference/ Conducted / Sponsored Inclusive Dates

Workshop / Short Courses By:
1. Capacity building on Child Protection Policy DepEd – Tanauan City November 21-23, 2017

And Values Formation among Student

Leaders and Advisers

2. Telebibo: Media and Television Literacy National Council for November 8-10, 2017

Seminar Workshop for Children National Children’s Television

Council for Children’s Television

3. #BreakTheRecord Student Leader’s Kristiyanong Kabataan July 25, 2017

Summit Para sa Bayan
4. Division Leadership Training for Student DepEd - Tanauan City May 4-6, 2017
Government Officers
5. Benchmarking and Capacity Building cum DepEd – Tanauan City and Aug. 22-24, 2017
Workshop on the preparation of Activity La Consolacion College
Proposal, School Memorandum,
and Letter Request

ONE DIVISION, ONE HEART

Department of Education
DIVISION OF TANAUAN CITY

SEARCH FOR OUTSTANDING YOUNG LEADERS

NOMINATION FORM

Please write legibly. Mark appropriate boxes with “ / “ and use separate sheet if necessary.

Choose one: Elementary Secondary

Category: Individual Group

Name of School : EUNICE M. CABRERA

SSG/SPG Position : PRESIDENT

PERSONAL INFORMATION

Surname : CABRERA

First Name : EUNICE Nickname : EUNICE

Middle Name : MENDOZA

Date of Birth : APRIL 12, 2001 Residential Address : MA.PAZ, TANAUAN CITY, BATANGAS

Place of Birth : MAHABANG BUHANGIN, BRGY MA. PAZ, TANAUAN CITY, BATANGAS

Sex: Male Female Tel. No. : __________________ Cell No. : 0975-533-6993

Citizenship : FILIPINO Religion : ROMAN CATHOLIC Email : emcstyles@yahoo.com

ONE DIVISION, ONE HEART

Department of Education
DIVISION OF TANAUAN CITY
EDUCATIONAL BACKGROUND

Level Name of School & Address Gen. Ave. Inclusive dates

Elementary : MAHABANG BUHANGIN ELEMENTARY SCHOOL _________ ______________

Secondary : BOOT NATIONAL HIGH SCHOOL _________ ______________

ACADEMIC HONORS / AWARDS RECEIVED (Start from most recent)

Name of Award Awarding Body Inclusive Dates

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

______________________________________ ___________________________ _______________

NON-ACADEMIC HONORS / AWARDS RECEIVED (Start from most recent)

Name of Award Awarding Body Inclusive Dates

1. 1ST Quiz Bee in Math Boot NHS Math Club _______________

2. 5th Hair and Make-Up (Division) DepEd – Tanauan City _______________

3. 1st Hair and Make-Up (School Level) Boot NHS TLE Club _______________

4. 1st Badminton (School Level) Boot NHS MAPEH Club _______________

ONE DIVISION, ONE HEART

Department of Education
DIVISION OF TANAUAN CITY

EXTRA-CURRICULAR AND CO-CURRICULAR ACTIVITIES (Start from most recent)

Position / Title Organization’s Name Inclusive Dates

ECO-CLUB\PIO BOOT NHS ECO-CLUB 2017-2018

BE KICK-OFF DepEd TANAUAN CITY MAY 15, 2017

CHAPEL SERVER BLC MAHABANG BUHANGIN 2013-PRESENT

TRAINING PROGRAMS ATTENDED (Start from most recent)

Title of Seminar/ Conference/ Conducted / Sponsored Inclusive Dates

Workshop / Short Courses By:CLUC
1. Telebibo: Media and Television Literacy National Council for November 8-10, 2017

Seminar Workshop for Children National Children’s Television

Council for Children’s Television

2. #BreakTheRecord Student Leader’s Kristiyanong Kabataan July 25, 2017

Summit Para sa Bayan
3. Division Leadership Training for Student DepEd - Tanauan City May 4-6, 2017
Government Officers

ONE DIVISION, ONE HEART

Department of Education
DIVISION OF TANAUAN CITY

ATTESTATION AND AUTHORIZATION

I attest to the truth of all the foregoing facts and the authenticity of the documents attached to this
form. I authorize the organizers to copy, reproduce or publish my nomination form and all related
materials submitted, including any and all information obtained in the process of screening and
evaluation for whatever legal purposes it may serve without need for any compensation. I understand
that if any of the above given information are proven to be false, I will automatically be disqualified from
this contest.

EUNICE M. CABRERA 11-20-17

Signature over Printed Name of Student Date signed

JINKY M. CABRERA 11-20-17

Signature over Printed Name of Student Date signed
_____________________________________________________________________________________

EUNICE M. CABRERA
Name of Nominee

LETTER OF NOMINATION AND CERTIFICATION

I hereby nominate the above-mentioned student for the division search for ten outstanding young
leaders for the reasons stated in the attached sheet.

I further certify that our school organized a school level committee and the above-mentioned student
after due deliberation was selected as nominee for the division search.

ANALOU C. CRUZ 11-21-17

Section Adviser Date Signed

JOSEFINE J. MAGPANTAY 11-21-17

Section Adviser Date Signed

ONE DIVISION, ONE HEART