Republic of the Philippines

North Eastern Mindanao State University

Bislig Campus
Formerly Surigao del Sur State University
Maharlika, Bislig City, Surigao del Sur
bislig.sdssu.official@gmail.com
(086) 645-6452

Application for Recognition and Awards

Academic Year: _______ to ________

To the Awards and Screening Committee:

Please consider the undersigned as applicant for recognition based on the merits and
validity that hereinto presented:

ACADEMIC AWARDS PLS CHECK REMARKS

Summa Cum Laude(1.20 – 1.00 )
Magna Cum Laude ( 1.45 – 1.21)
Cum Laude (1.75 – 1.46)
With Highest Distinction (non-degree courses)
With High Distinction (non-degree courses)
With Distinction (non-degree courses)
Academic Performance Award
NON-ACADEMIC AWARDS
Leadership Award
College Leadership Award (for College Governors only)
Special Leadership Award (for SSG Presidents only)
Athlete of the Year/Literary
Provincial (bronze)
Regional (silver)
National (gold)
Special Talent Award
Loyalty Award
Best Practicum/Practice Teacher Award
Service Award

Hereunder are summary of my achievements to substantiate my application to be an

awardee: (pls attach in separate page the documents)

DATE ACTIVITY ELECTED NAME OF ATTESTED BY

POSITION ORGANIZATION COACH/ADVISER
(For academic (For academic
awards only) awards only)

I fully understand that this is still subject for the approval of the screening/ evaluation. Please
notify the undersigned for the approval/dis approval of this application for my guidance.

______________________________
Signature over Printed Name

FM-OSAS-OO5G
 Republic of the Philippines
North Eastern Mindanao State University
Bislig Campus
Formerly Surigao del Sur State University
Maharlika, Bislig City, Surigao del Sur
bislig.sdssu.official@gmail.com
(086) 645-6452

Attested:

HERMELIE C. PASOS JOSEPHINE E. MADAYAG

Campus Registrar Sports Coordinator

CRISTINE D. GULFO GINALYN P. ESTOSE

Culture and Arts Coordinator Guidance Counselor

Recommending Approval:

VIRGILIO T. OMBAO JR. CRISTINE D. GULFO

BTVTED Program Head Head, Students Welfare and Development

Approved:

FRANCO G. PANTALEON, PhD

Assistant Campus Director

IMPORTANT REMINDER:

a. Candidates for graduation with honors must have evidence on participation in both extra and co-curricular activities of at least two
activities and must be an official of at least two recognized organizations of the school. (Subject to the evaluation of the Head for the
Students Affairs and Club Advisers).
b. Candidates have never found guilty of misconduct and other misbehavior by the Guidance Office, College Adviser, College Chair,
Faculty Members and School personnel, and
c. Must have a residence of whole curriculum year for Summa Cum Laude, 3 years for Magna Cum Laude and 2 years for Cum
Laude.

NOTE: Please submit the completed form to the respective deans for evaluation and final listing of awards

FM-OSAS-OO5G