11/F Aurora Tower, Araneta Center, Quezon City 1109

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Tel. Nos.: 9130439; 9113101 ext. 7411, Fax No.: 4214006
E-mail: grfawardees@gerryroxasfoundation.org | Website: www.gerryroxasfoundation.org

GERRY ROXAS LEADERSHIP AWARDEE (GRLA)

INFORMATION SHEET
Each awardee MUST FILL UP this form and mail back to Gerry Roxas Foundation. Submission of this form will enable GRF to include
this year's awardee in the database and qualifies the school to remain in "active" status as a partner of GRF.

PERSONAL INFORMATION
NAME OF AWARDEE: Last Name First Name Middle Name DATE OF BIRTH:
(yyyy/mm/dd)

COMPLETE MAILING ADDRESS: Landline Number Area

Code:______________
No. _____________________

SEX: CIVIL STATUS: EMAIL ADDRESS: CELLULAR PHONE NO.

NAME OF SCHOOL: YEAR GRADUATED FROM HIGH

SCHOOL:

SCHOOL ADDRESS: (No.)(Street) (Barangay/Municipality) ( City/Province) (Region)

FATHER'S NAME : Last Name First Name M.I. OCCUPATION :

MOTHER'S NAME : Last Name First Name M.I. OCCUPATION :

PARENT'S ADDRESS:No.)(Street) (Barangay/Municipality) ( City/Province) (Region) NO. OF SIBLINGS:

WHERE DO YOU INTEND TO STUDY FOR COLLEGE? COURSE & REASON FOR CHOOSING/TAKING IT:

SCHOOL & /OR COMMUNITY INVOLVEMENT

POSITIONS HELD IN SCHOOL
COMMUNITY INVOLVEMENT ORGANIZATIONS DURING HIGH SCHOOL AWARDS RECEIVED

Why do you think were you given the Gerry Roxas Leadership Award? GRLA Score Sheet Summary:
To be filled up by the Class Adviser

Integrity -
Service -
Excellence -
Extra Curricular -

Total:

GRL AWARDEE: DATE: PRINCIPAL: DATE:

_______________________ _______________________ _______________________ ____________________

Signature Signature