ANNEX A

R&R Form 1 (Nomination Form)

RO 7 PASIDUNGOG SEARCH Passport size

Photo

Individual Category : _N.A.__________ (Teacher, School Head, Non-Teaching Level 1 and 2)

Nominee (First Name, Middle Name, Last Name): Signature:
ANA VANESA S. CAMARILLO
Position ( per Service Records): TEACHER 1 Gender: FEMALE Age: 30
Status of Appointment ( per Service Records): Date of Birth
PERMANENT AUGUST 25,1992
Telephone/Cellphone Nos (Active Contact Details): Place of Birth:
09120955221 ICKMH, ARGAO, CEBU
Residence Address: LINUT-OD, ARGAO, CEBU
Level of Position: Group
Category: GULAYAN SA
 1st Level  2nd Level  3rd Level (SDS/ASDS) PAARALAN
 Teaching Related  Non-Teaching  Teaching Nominee (Name of School/ Name of SDO):
LINUT-OD ELEM. SCHOOL/ CEBU
PROVINCE
Email Address: Size (small,medium, large):
anavanesa.camarillo@deped.gov.ph small
SCHOOL HEAD
Name: IMELDA S. SARDIDO Position: HEAD TEACHER III
Office/Office Address: LINUT-OD ELEMENTARY SCHOOL
Telephone/Cellphone Nos. (Active Contact Details): Email Address:
09612412858 imelda.sardido@deped.gov.ph
DISTRICT
Name: IMELDA H. GEALON Position: PSDS
Office/Office Address: ARGAO II DISTRICT, TALOOT, ARGAO, CEBU
Telephone/Cellphone Nos. (Active Contact Details): Email Address:
09991029930 imelda.gealon@deped.gov.ph
NOMINATOR
Name: IMELDA S. SARDIDO Position: HEAD TEACHER III
Office: LINUT-OD ES Telephone/Cellphone Nos.: 09612412858
Office Address:LINUT-OD, ARGAO,CEBU Email Address: imelda.sardido@deped.gov.ph
 Additional Information of Nominee:

Were you a previous PASIDUNGOG Nominee?  Yes  No What year:

______
What Award Category?

Were you a previous PASIDUNGOG Semi-finalist?  Yes  No What

year:_____
What Award Category?

Were you a previous PASIDUNGOG Awardee?  Yes  No What year:

_____
What Award Category?
ANNEX B
R & R Form 2 (Nomination Write-up for all Categories)
Nomination Write-up:
(Minimum of 250 words and Maximum of 500 words, A4 size bond paper, Arial # 12
font, including executive summary)
Name of Nominee: (including Category): (Group Category):
ANA VANESA S. CAMARILLO GULAYAN SA PAARALAN
Position: TEACHER 1 Name of School/District
Length of Service in the Position: 6 years Head of Office:
in Government: 6 years MRS. IMELDA S. SARDIDO

I. Executive Summary
DepEd Memorandum No, 293, s, 2007 entitled Gulayan sa Paaralan was
issued to support the hunger mitigation and raise awareness about health
and nutrition, among students, teachers and parents and sustain the
School-Based Feeding Program.
To sustain the school GPP and developed among learners the art of
gardening, and to harvest fresh produced, the school participated in
SUGBUsog sa Eskuylahan, initiated by our Governor which has the same
aim. Together with the stakeholders of the school, every criteria and more
met for we are united driven in one goal, which is for the betterment of the
learners. With this unity, the school was able to generate Php45,000.00
funds to support the GPP/SUGBUsog Program and in turn, the effort was
rewarded and won second place in the District Level.

II. Exemplary Behavior/ Conduct Displayed within the last 3 years

 Stakeholders strong support in every program initiated and
harmonious relationship.
 Each committee works together by gathering old tires, collecting
seeds, bamboos, soil etc.
 Transparency, unity, camaraderie
 Raise funds and support to address GAPS

III. Impact Accomplishments (indicate problems addressed, savings generated, people/

office benefited and transactions facilitated. Indicate whether or not the accomplishments
are part of the nominee’s regular functions/ mandated or the product of his/her/their own
initiative. If part of nominee’s regular duties or mandated, justify why the
accomplishments are considered exemplary or extraordinary)
 SBFP for all learners-from produced vegetables.
-regular function
-not only the malnourished children was given foods but all of the
school children.
 Generated Php45,000.00 – whole school
 -regular function
-established nursery, vermi-composting, aquaponics
-provide realia learning environment
 Laboratory for learners
 Inculcate the value of gardening, good health and nutrition, love of
labor and caring for others
 It enhanced the academic performance of the learners through
proper nutrition obtained from the harvested vegetables from the
school.

Other Information (Major Awards/Citations Received/ Membership in the Organization)

2nd Placer SUGBUSog sa Eskuylahan District Level
2nd Placer SUGBUSog sa District Municipal Level
2nd Placer BEST BRIGADA ESKWELA SCHOOL IMPLEMENTER
2nd Placer 5S Cluster A Level

CERTIFICATION
We/ I attest to all facts contained herein and authorize the use of these information for
publication. We understand that the Committee on Awards will validate the accuracy of the
information contained in this form and grant our consent to the conduct of a background
investigation. Any misrepresentation made by the signatories shall be a ground for disciplinary
action pursuant to applicable Civil Service laws and rules and DepEd RO VII/Division Rewards
& Recognition Policy.

Printed Name and Signature:

ANA VANESA S. CAMARILLO IMELDA S. SARDIDO NIELSEN G.VILLEGAS IMELDA H. GEALON

Nominee Nominator District R & R Public Schools
District
Focal Person Supervisor
ANNEX C
R & R Form 3 (Omnibus Certification for Individual & Group Categories)

OMNIBUS CERTIFICATION OF AUTHENTICITY

AND VERACITY OF DOCUMENTS

I, _____ANA VANESA S. CAMARILLO_________, Filipino, of legal age, with permanent

address at ___LINUT-OD, ARGAO, CEBU__________, after being sworn in accordance with law,
hereby depose and state that:
1. I am applying for __MOST OUTSTANDING PROGRAM IMPLEMENTER______ at
GULAYAN SA PAARALAN_ LINUT-OD ELEMENTARY SCHOOL DISTRICT OF ARGAO II,
Name of Category Name of School/Division
__LINUT-OD, ARGAO, CEBU______________;
Address of School/Division

2. I have submitted the following documents:

Fully Accomplished Rewards and Recognition Forms
2.1 Nomination Form (Form 1)
2.2 Nominee’s Write-ups on the Highlight of Accomplishments
(Form 2)
3. Updated PDS with passport size (1 ½” x 2) photo with name tag taken within the
last six (6) months prior to the nomination.
4. Endorsement letter from the Schools Division Superintendent/ Chairperson of the
Division PRAISE Committee or its equivalent, that the nomination has undergone
deliberation by the Committee.
5. Certification of No Unliquidated Cash Advances signed under oath by the agency’s
Financial Officer/ Accountant and Certification of No Disallowances issued by the
COA Resident Auditor for previous accountabilities as of December 31, 2019. In
case of existing unliquidated cash advance and disallowance, a certificate of the
status of such financial obligation shall be issued by the COA Resident Auditor.
6. Certificate of no pending administrative/civil/criminal case;
7. Updated service record duly certified by the agency’s Human Resource Management
Officer (HRMO).
8. Performance Rating for the last three (3) performance rating periods prior to the
nomination.
9. I am executing this Certification as to attest to the authenticity and veracity of all
documents submitted.
10. By executing this Omnibus Certification of Authenticity and Veracity of
Documents, I hereby authorize the Department of Education, Division of _CEBU
PROVINCE_____, to verify the authenticity of the above mentioned documents.

_ANA VANESA S. CAMARILLO

Signature Over Printed Name

___October 24, 2022____

Date

SUBSCRIBED AND SWORN to before me in City/Municipality ___ARGAO II_________________

this _____ day of ________________, 20____, affiant exhibiting to me his /her Community Tax
Certificate No. _24133505_______ issued on _1-11-2022__________ at __LINUT-OD, ARGAO,
CEBU_________, Philippines.
________________________________
Notary Public