Republic of the Philippines

PROVINCE OF ORIENTAL MINDORO

OFFICE OF THE GOVERNOR
PROVINCIAL YOUTH DEVELOPMENT OFFICE
PROVINCIAL YOUTH DEVELOPMENT COUNCIL
Provincial Capitol Complex, Barangay Camilmil, Calapan City 5200, Oriental Mindoro

I. PERSONAL INFORMATION

Name
First Name Middle Name Last Name Insert 2x2 picture

Or
Nickname Religion
Send your 2x2 picture
Date of Birth Age Sex through this email
month/date/year
pydcormin@yahoo.com

Permanent Address

Province& Region

Facebook Account

E-mail Address

Contact Number
Mobile Landline

Allergy and Dietary Restrictions

Pre-existing Medical Conditions
II. EDUCATIONAL BACKGROUND
Name of School & Address Inclusive Dates Highest Level Attained
High School
College
Vocational
Post-Graduate
III. MEMBERSHIP IN ORGANIZATIONS
Name of Organization & Address Inclusive Dates Position Held

(Use additional sheet for additional entries.)

IV. COMMITTEE MEMBERSHIP
Rank the following according to your area of interest, with 1 being the highest and 5 being the lowest.
(Your preference will be considered in identifying your committee assignment during the Parliament.)

Education Health

Employment Youth Participation

Environment

V. ESSAY
Describe your Advocacy
Important: Limit your answer to major and important words.

VI. PROPOSED ORDINANCE

1.
2.
3.
PARENTAL CONSENT
(For Applicants Below 18)
I, , mother, father, legal
guardian of Ms./Mr. do hereby declare that I have read
 Republic of the Philippines
PROVINCE OF ORIENTAL MINDORO
OFFICE OF THE GOVERNOR
PROVINCIAL YOUTH DEVELOPMENT OFFICE
PROVINCIAL YOUTH DEVELOPMENT COUNCIL
Provincial Capitol Complex, Barangay Camilmil, Calapan City 5200, Oriental Mindoro

the information provided above and decided to allow my child to participate.

SIGNATURE OVER PRINTED NAME

Date Accomplished