GIRL SCOUTS OF THE PHILIPPINES

National Headquarters 2” X 2”
Manila PHOTO

CGSMS Form No. 1

CHIEF GIRL SCOUT MEDAL SCHEME

APPLICATION FORM

I. PERSONAL INFORMATION
Name : BAI ALIAH M. PAIDOMAMA_____________ _______ ____
Address : PUROK TAGUMPAY, BRGY. ARINGAY, KABACAN NORTH COTABATO
Telephone No. : 09094445557 Troop No.: 04 – CADET
Region : WESTERN MINDANAO________ Council: NORTH COTABATO
Troop Leader : ARABELLA M. SOBERANO ________________________
Parents : ENGR. GERRY PAIDOMAMA & PROF. SANDRA PAIDOMAMA ______
Occupation : GOVERNMENT EMPLOYEE & TEACHER _______ __________
Registration Dates : __________________________________________________________
Three (3) Years of Girl Scouting Experience
STAR SCOUT__________________________________________________________________
JUNIOR GIRL SCOUT____________________________________________________________
SENIOR GIRL SCOUT____________________________________________________________

II. BADGE WORK (2 badges for each of the 8-Point Challenge)

Badges Earned Challenge Dates Earned

1. PERFORMING ARTS BADGE ARTS JULY 3, 2015
2. SONG LEADER BADGE ARTS JULY 7, 2015
3. WORD OF GOD BADGE SPIRITUALITY AND WELL-BEING JULY 31, 2015
4. LOOK AT MYSELF BADGE SPIRITUALITY AND WELL-BEING AUGUST 14, 2015
5. RECYCLING BADGE ENVIRONMENT AUGUST 28, 2015
6. ECOLOGIST BADGE ENVIRONMENT SEPTEMBER 11, 2015
7. COOKERY BADGE ECONOMIC SELF-SUFFICIENCY SEPTEMBER 25, 2015
8. NEEDLEWORK BADGE ECONOMIC SELF-SUFFICIENCY OCTOBER 9, 2015
9. HARMONY IN DIVERSITY WORLD COMMUNITY OCTOBER 23, 2015
10. TRAVELER'S BADGE WORLD COMMUNITY NOVEMBER 6, 2015
11. COMMUNITY SERVICE BADGE HERITAGE AND CITIZENSHIP NOVEMBER 20, 2015
12. CHRONICLER BADGE HERITAGE AND CITIZENSHIP DECEMBER 4, 2015
13. LIFE SAVER BADGE PREPAREDNESS JANUARY 8, 2016
14. HOME NURSE BADGE PREPAREDNESS JANUARY 22, 2016
15. ME AND MY FAMILY BADGE FAMILY LIFE FEBRUARY 5, 2016
16. FAMILY ADVENTURE BADGE FAMILY LIFE FEBRUARY 19, 2015
III. CAMPING RECORD

Encampment Date Place

Troop: SCOUTS DAY NOVEMBER 24-26, 2010 KABACAN WESLEYAN ACADEMY

District: PLTC OCTOBER 2015 KABACAN WESLEYAN ACADEMY

Council: 38TH CAMPING YEAR NOVEMBER 18- 23, 2016 CAMP AURORA, BULATUKAN

Regional:

National:

International:

IV.CHIEF GIRL SCOUT MEDAL SCHEME ORIENTATION WORKSHOP

Date: JULY 22, 2016 Place: UNIVERSITY LABORATORY SCHOOL

Submitted by:

BAI ALIAH M. PAIDOMAMA

Chief Girl Scout Medal Scheme Candidate

Noted by:

ARABELLA M. SOBERANO
Troop Leader

NIMPHA SILVANO
Council Executive

TITA G. ALVAREZ
Regional Executive Director

Attachments:
1. Troop Leader’s Endorsement
2. Parent’s Endorsement
3. Community Profile

Due_EO August
 Republic of the Philippines
University of Southern Mindanao
University Laboratory School
Kabacan, North Cotabato

TO WHOM IT MAY CONCERN:

Request be informed that Bai Aliah M. Paidomama, daughter of Engr. Gerry

Paidomama and Prof. Sandra Paidomama, 16 years of age, born on the 7th day of

November year 2001 and an active resident of Kabacan, North Cotabato. An incoming

Grade 10, studying at University Laboratory School, Kabacan, North Cotabato.

Aliah had shown and developed her sense of responsibility, aggressiveness and

interest in all activities in the school. She is a good student, good friend, good daughter

and a good Filipino citizen. She is a good leader and model of the Girl Scout with

Filipino Spirit who has the dignity to wave the banner of the supremacy of the Girl Scout

of the Philippines.

As a troop leader, I have the honor to recommend Rohvel Honey Blossom M.

Salon as a candidate of Chief Girl Scout Medal Scheme.

ARABELLA M. SOBERANO

Troop Leader
 Republic of the Philippines
University of Southern Mindanao
University Laboratory School
Kabacan, North Cotabato

TO WHOM IT MAY CONCERN:

Bai Aliah, 16 years old, the 2nd daughter of Engr. Gerry Paidomama and Prof. Sandra

Paidomama. She was born on November 7, 2001. She is an incoming Grade 10 student,

studying at University Laboratory School – University of Southern Mindanao.

Our daughter has always shown great concern in various aspects of her life, in her

family, in the school and in the community. She is a dependable and responsible child in

whatever task assigned to her. She is a leader and a diligent girl.

With her enthusiasm and love to do great things, we are favorably recommending our

daughter, Bai Aliah M. Paidomama, to work for the Chief Girl Scout Medal Scheme. This will

provide her the opportunity to be a better citizen of our country. This project will not only make

her a better person but enables her to apply and internalize the Girl Scout Promise and Law by

heart.

ENGR. GERRY PAIDOMAMA

Father

PROF. SANDRA PAIDOMAMA

Mother
 CGSMS Form No. 1- A

COMMUNITY PROFILE

1. Name of Purok/Zone: PUROK MIRACLE Population: _174________

2. Barangay: ARINGAY Municipality/Province/City: KABACAN, NORTH COTABATO
3. No. of Families in the Purok: 26 No. Interviewed: _2_ No. of houses: 23
4. No. of houses: __23___ Light materials: __16___Concrete: ____ _7__
5. No. of houses with:
Toilets:___________20________ ___Flower gardens: __________8_____________
Electricity:________ 19___________ Vegetable gardens:_ ______ 15________
Running water: 14 Poultry:______ 8_____ _ _
Artesian well: _________8____ Piggery:____________1_______ ___
Others (specify): cattle raising
6. No of school/s in the purok/zone : None
7. No. of church/ chapel in the purok/ zone : 1
8. Governments offices located in the purok/ zone : None
9. No. of hospital/ clinic in the purok/ zone :None
10. Community centers available like day care, reading, health center, others (specify) in the
purok/ zone : None
11. Means of transportation available in the purok/ zone : Motorcycles, Tricycles, Bicycle
12. Recreational facilities available in the purok/ zone : Basketball Court
13. Means of livelihood/ occupation/ employment of the people in the purok/ zone :
Farming, Fishing, Small Business (Sari Sari Store)
14. Educational Attainment of the: (Indicate number)
Men (Elementary, High School): 35
Women (Elementary, High School): 41
15. No. of school children of school age (6 yrs. – 21 yrs.)
In- School: 76 _____
Out-of-school: 13
16. General condition of
Roads: ________Poor_____________ Playground for children: None
Drainage: ______Good____________ Market: _______________ None
Plaza: _________None_____________ Garbage disposal: __________Good___
Trees and other plants: ____Very Good_________
17. Person’s Interviewed: SENYOL MANIBPAL
Identified Community Problems/ Needs:
a.) ELECTRICITY
b.) MADRASAH
c.) ROAD
BAI ALIAH M. PAIDOMAMA
Chief Girl Scout Medal Scheme Candidate

JULY 22, 2016

Date/s of Survey
Noted:

ARABELLA M. SOBERANO__
Troop Leader