LA SALLE UNIVERSITY

Ozamiz City

GRADUATION AWARDS NOMINATION FORM

(PLEASE TYPE ANSWERS, USE ADDITIONAL SHEETS IF NECESSARY)
(ATTACH SUPPORTING PAPERS)

NAME OF AWARD:
NOMINEE’S FULL NAME: SEX: CITIZENSHIP:
HOME ADDRESS:
DATE OF BIRTH: PLACE OF BIRTH:

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POSITION HELD IN ORGANIZATIONS

POSITION ORGANIZATION
FIRST YEAR

SECOND YEAR

THIRD YEAR

FOURTH YEAR

TERMINAL YEAR

Please attach
INVOLVEMENT IN ACTIVITIES IN / OFF CAMPUS
A
EXTENT/NATURE OF
clear
INVOLVEMENT
ACTIVITY SPONSORING AGENCY
(Representative,
photo of you
Organizer, Etc.)
FIRST YEAR

SECOND YEAR

THIRD YEAR

FOURTH YEAR

TERMINAL YEAR
 INVOLVEMENT IN COMMUNITY DEVELOPMENT PROJECTS IN/OFF CAMPUS

EXTENT/NATURE OF
TITLE OF SPONSORING AGENCY/ PARTICIPATION
PROJECTS/SEMINARS DATE HELD (Speaker, Facilitator,
Leader, Participants, etc.)
FIRST YEAR

SECOND YEAR

THIRD YEAR

FOURTH YEAR

TERMINAL YEAR

SPECIAL ACADEMIC HONORS/AWARD/DISTINCTIONS RECEIVED

AWARD SPONSORING AGENCY

FIRST YEAR

SECOND YEAR

THIRD YEAR

FOURTH YEAR

TERMINAL YEAR