2018 Gawad Tsanselor sa Natatanging Mag-aaral

NOMINATION FORM

GAWAD TSANSELOR PARA SA NATATANGING MAG-AARAL

Office of the Vice Chancellor for Student Affairs
Ground Floor, Quezon Hall Attach
University of the Philippines Diliman black and white
Diliman, Quezon City 2x2
Telefax + 63 2 9282886 photo here
Email. ovcsa.upd@yahoo.com /upd@upd.edu.ph

It is my pleasure to nominate:

Name of Nominee
_______________________________________
Course
_______________________________________
Signature

for the 2018 GAWAD TSANSELOR PARA SA NATATANGING MAG-AARAL. We hereby certify that,
to the best of our knowledge, the information contained in this nomination form and the
accompanying supporting documents are true and correct.

Signature over Printed Name

e-mail address Telephone Number

Fax Number Mobile Number

Date

Signature over Printed Name

e-mail address Telephone Number

Fax Number Mobile Number

Date

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 2018 Gawad Tsanselor sa Natatanging Mag-aaral

PERSONAL BACKGROUND of the NOMINEE

_____________________________________________________________________________________
Last Name First Name Middle Name

_____________________________________________________________________________________
Home Address

_____________________________________________________________________________________
Residence Telephone Number Mobile Number Email Address

_____________________________________________________________________________________
Date of Birth Age Civil Status

_____________________________________________________________________________________
Citizenship Gender

Family Background:
Name Age Profession/Occupation
Father: ___________________________________________________________________________

Mother: ___________________________________________________________________________

Brother/s: ___________________________________________________________________________

___________________________________________________________________________
___________________________________________________________________________
Sister/s: ___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

EDUCATION
School Attended Level/Course/Degree Inclusive Years
Elementary
High School
College
Others

Did you drop any subject during your entire stint in the course for which you are nominated?
 YES  NO
Did you withdraw any subject during the aforementioned period?
 YES  NO

If yes, please state the subject(s) and reason(s) for dropping or withdrawing:
_______________________________________________________________________________________________
_______________________________________________________________________________________________

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 2018 Gawad Tsanselor sa Natatanging Mag-aaral

EDUCATIONAL BACKGROUND
Table below maybe replicated for each school year.

Academic Honors and Awards1

School Year:______________________
Date Name of
Organization giving the
(MM-DD- Rank Honor/Award Description of Honor/Award Received Level 3
YY)2
award
Received

Publications, Performances, Conference Paper Presentations, Compositions and Musical Arrangements4

School Year: ______________________

Date Name of
Organization giving the
(MM-DD- Rank Honor/Award Description of Honor/Award Received Level3
YY)2
award
Received

1
Include academic honors and awards received from academic institutions, organizations, and contests.
2Honors and awards must be arranged in chronological order from most recent to earliest. Date column must be filled – up with month-date-year entries
3For the LEVEL Column, use this legend: I – International; N – National; R – Regional; P – Provincial; C – City; S – School
4Include published articles and papers; performances, compositions and musical arrangements

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 2018 Gawad Tsanselor sa Natatanging Mag-aaral

EXTRA-CURRICULAR ACTIVITIES
Table below maybe replicated for each school year.

Co- and Extra-Curricular Activities and Awards5

School Year:_______________________
Name of Activity
Date Description of Activity and
and your Role in Organized By Beneficiary Level 6
(MM-DD-YY) Your level of Involvement
the Activity

Civic Activities, Community Involvements and Public Service7

School Year:_______________________
Name of Activity
Date Description of Activity and
and your Role in Organized By Beneficiary Level6
(MM-DD-YY) Your Involvement
the Activity

5 Include co and extra – curricular activities, programs, projects, or organizations that a nominee has been involved with/in such as student council, academic –
related organizations, or school-based volunteer organizations.
6For the LEVEL Column, use this legend: I – International; N – National; R – Regional; P – Provincial; C – City; S – School
7Include civic engagements and community service involvements done voluntarily, separate from and independent of academic requirements. This includes

work done in the barangay, a charity or non-government organization, or a church, or done in connection with the school’s extension or social development
services.
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 2018 Gawad Tsanselor sa Natatanging Mag-aaral

CHECKLIST OF REQUIRED DOCUMENTS

 Nomination Form
 2 X 2 picture
 Nominee information
 Name and signature of Nominator

 Personal Background

 Educational Background

 Extra-curricular Activities

 Letter of Recommendation
 Letter of Recommendation from a person (except relatives) with a deep
knowledge of the personal story of the nominee (he or she may be a Professor,
Mentor, Counselor, Community or Church Leader or any person of notable repute
who has known/worked with the nominee. The letter of recommendation must
specify the reasons, circumstances, and impressions surrounding the nominee’s life
story that the Recommender thinks are vital to his/her recognition as an
outstanding student.

 Essays (not more than 300 words/essay)

 The nominee should write an essay for each of any two (2) questions out of the five
(5) given below. His/her answer should be typewritten and not be more than 300
words per essay.
1. What does being an Iskolar ng Bayan mean to you?
2. What inspires you to be an outstanding student?
3. Among all of your advocacies and aspirations, which defines and inspires you
the most?
4. What is the essence of this award and recognition to you?
5. What does ‘honor and excellence in the service of the people’ mean to you?

 Scholastic Records
 Transcript of Records/Certified True Copy of Grades (should include all subjects with
grades taken by the nominee from first year college to the first semester of the school
year 2017-2018 and computed GWA/GPA for each semester.)
 Certification of GWA/GPA from the College Secretary
 Certification from the Dean and/or College Secretary that the nominee is in good
academic standing;
 Certification from the Dean and/or College Secretary that the nominee has
consistently carried a normal academic load, or the same certification of a
justification of instance(s) of under loading;
 Certification from the Dean and/or the College Secretary that the nominee has not
incurred grades of “4” and “5” and does not have an unremoved “Inc.”;
 OUR-certified record of shifting and leaves of absence, and the nominees justification
of the leave of absence, if any;
 Certification from the Student Disciplinary Tribunal AND the Dean and/or College
Secretary that the nominee has not been found guilty in any disciplinary case in the
University

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 2018 Gawad Tsanselor sa Natatanging Mag-aaral

 Supporting Documents
 Photos of awards with descriptive captions (name of honor/award, date, venue, and
award-giving bodies) and copies of newspaper clippings and certificates;
 Copies of certificates, newspaper clippings, photos of activities (name of activity,
date, venue, and organizing bodies), and photos of awards (for co- and extra-
curricular awards)

 Copies
 Original
 Photocopy
 CD copy

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