Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

115 East 57th Street, Suite 1430, New York, NY 10022

US Pinoys for Good Governance Essay Contest on West Philippine Sea


OFFICIAL ENTRY FORM
TO BE COMPLETED BY STUDENT (please print)
Name: First______________________ Middle_____________________ Last ____________________________
Age:____ Date of Birth(month/day/year):____________Grade:______Year:________ Course:________________
Address: Apt./ House No.__________ Street:_________________________________________________________
Town/City:______________State/Province:________________Country:________________Postal/ZipCode:______
Email address:_____________________________ Telephone/Cellphone No: (___)________-________________
School/College/University Name:__________________________________________________________________
Address:______________________________________________________________________________________
Telephone No: (____) _________-________________ Cell Phone No.: (___) __________- ___________________
ReferringTeacher/Professor:Name:_____________________________Signature:_________________________
How did you hear about this essay contest? Please check that applies:
[ ]TV [ ] Radio [ ] Newspapers [ ]Email [ ]Friend [ ] USP4GG website [ ] Other:_________________________
Why did you join this essay contest?________________________________________________________________
Signature: ____________________________________

Date:________________________

TO BE COMPLETED BY SCHOOL PRINCIPAL/COLLEGE/UNIVERSITY DEAN OR PRESIDENT


CONFIRMATION
The undersigned highly recommends ______________________________to participate in the USP4GG Essay Contest on West Philippine Sea
Name of Student
and confirms that the essay is written by and originated from this student.
Principal/College/ University Dean or President(in print)___________________________Signature_________________________________
Name of School/College/University_______________________________________________________________________________________
Address:_____________________________________________________________________________________________________________
Telephone No:__________________Cellphone No :__________________Email Address:__________________________Date:___________
CBL/10/31/2012

You might also like