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Dean's Lister Form
Dean's Lister Form
Founded 1993
PACUCOA Accredited
OFFICE OF THE VICE PRESIDENT FOR ACADEMIC AFFAIRS
Blk. 13, Lot 26, Fatima 1, Area E, Sapang Palay, City of San Jose del Monte, Bulacan
APPLICATION
PERSONAL DATA: FOR DEAN’S LISTER
PERSONAL DATA:
Applicant’s Name : ____________________ 2x2 picture
Age : ____________________
Course : ____________________ white
Contact No. : ____________________
Address : _____________________________ background
_____________________________
Date Filed : _________________ Formal attire
Applicant No. : ________
SCREENING:
To be filled in by the concern staff: Please affix your signature in the box that signifies
your response.
STAFF TO RECOMMENDATION
PERCENTAGE
RECOMMEND QUALIFIED NOT-QUALIFIED
25% Recommendation
-College Dean
25% Behavior
-College Guidance
Counselor
50% Evaluation (Grade
Requirement)
-VPAA Office
100% TOTAL
Over-all Result:
APPROVED BY:
NOTED BY:
I am aware that I need to attend the Dean’s Lister Ceremony to be able to get my certificate. If I
do not attend the program, I won’t get my dean’s lister certificate.
_________________________
Signature over printed name