PERSONAL INFORMATION

Name Nickname Age School Course/ Major

Last Name First Name Middle Name

Gender

Religion Birthdate (mm/dd/yyyy) Year Level

MAILING ADDRESS
House #, Street Town or City and Zip Code Phone Number Barangay/ Village Province and Region Mobile Phone Number Email Address

FAMILY DATA
Father Mother Guardian Number of Siblings

COLLEGE AWARDS

Name of Award

Type of Award (Academic/ Student Government/ Community-based, etc.)

COLLEGE LEADERSHIP
School Year Position Name of Organization

COMMUNITY INVOLVEMENTS
Month/Year Organization Event

HIGH SCHOOL AWARDS

Name of High School Address Name of Award Type of Award

HIGH SCHOOL LEADERSHIP

School Year Position Name of Organization

Answer honestly the following questions in a maxim

What are your hobbies/ special skills?

What events of the Federation have you participated in? (Regional and National)

What are your reasons for applying?

If elected, how can you achieve the goals and objectives of the organization?

What can you contribute to help this organization significantly?

What plan for NFJPIA will you implement once you are elected? How will you implement

REFERENCE
Name Relationship

List at least two (2) advisers/ mentors (e.g. your dean/ instructor) and

NOTE

Send this application form to nfjpiar1car.comelec@yahoo.com on or before January 19, 2013, wi COMELEC_<SURNAME>_<LOCAL CHAPTER> Other requirements (i.e. 2 to 4) are due on the day of the Annual Reg

REQUIREMENTS CHECKLIST

1. Duly accomplished application form 2. Endorsement Letter signed by the incumbent JPIA President, JPIA Adviser and dean 3. Certificate of good moral character from the Office of the Registrar and/or Office of the Prefect of Discipl 4. Certificate of grades or temporary transcript of record

N
Middle Name

ate (mm/dd/yyyy)

Wallet Size Picture

(white background)

gion Email Address

MILY DATA
Occupation Occupation Occupation

EGE AWARDS

Type of Award emic/ Student Government/ Religious/ Community-based, etc.)

Level (Department/ College/ University/ Barangay/ Provincial/ Regional/ National/ International Level)

GE LEADERSHIP
Level

Name of Organization

TY INVOLVEMENTS
Event Level

HOOL AWARDS

Type of Award

Level

OOL LEADERSHIP
Level

Name of Organization

questions in a maximum of 150 words.

onal and National)

organization?

? How will you implement this plan?

EFERENCE
Relationship Contact Number

our dean/ instructor) and three (3) peers/ colleagues

NOTE

or before January 19, 2013, with the following format as the e-mail's subject: NAME>_<LOCAL CHAPTER> ue on the day of the Annual Regional Convention.

MENTS CHECKLIST

and dean Office of the Prefect of Discipline