OFFICE OF STUDENT AFFAIRS AND SERVICES

Burgos Street, Bacolod City,

Negros Occidental, Philippines 6100
Tel. (034) 434 4561 local (123)

8TH UNIVERSITY HONORS’ DAY

OUTSTANDING STUDENT AWARDS

I. Nomination Form

STI West Negros University

Bacolod City, Negros Occidental 2x2 Picture
Assistant Vice President of Student Affairs and Services White Background
Nomination Form
With Collar or
School Uniform

To the esteemed members of the committee:

After reviewing the award general guidelines, it is our pleasure to nominate:

Name of Applicant
Department:
Program:
Signature: ____________________________________

to the 8th University Honors Day for Academic Year 2023-2024. We hereby
certify that to the best of our knowledge, the information contained in this
nomination form, and the accompanying supporting documents are true and
correct.

We hereby agree to send our candidate, for an intensive review of the

documents by the committee. We understand that the decision of the
selection committee is final and binding.

Department

College Dean
(Signature over Printed Name)
Date:

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 OFFICE OF STUDENT AFFAIRS AND SERVICES
Burgos Street, Bacolod City,
Negros Occidental, Philippines 6100
Tel. (034) 434 4561 local (123)

II-A. Nominee's Personal Data

Last Name First Name Middle Name Nickname

Home Address

Mobile Number Email Address Date of Birth Age

Civil Status Citizenship Gender

Family Background
Full Name Age Occupation / Status

Father:
Mother:
Brother/s:

Sister/s:

II-B. Nominee's Educational Profile

School Attended Inclusive Years

Elementary:
High School:
College:
Others:

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 OFFICE OF STUDENT AFFAIRS AND SERVICES
Burgos Street, Bacolod City,
Negros Occidental, Philippines 6100
Tel. (034) 434 4561 local (123)

III. ACADEMIC QUALIFICATIONS

General Qualifications:
1. All subjects taken by the student must strictly follow the required curriculum of the student’s course
program of the college
Specific Qualifications:
1. No grade marked FAILED in all subjects enrolled on the specific semesters mentioned in the
general qualifications.
2. No grade below 2.0 in all subjects enrolled on the specific semesters mentioned in the general
qualifications.
3. The grade from the Combined General Weighted Average on the specific semesters mentioned in
the general qualifications should not be lower than 2.0. FOR FRESHMEN, ONLY THE FIRST
SEMESTER IS CONSIDERED.
4. Here is the Combined General Weighted Average equivalence to Percentage in Academic Criterion

Combined General Weighted Academic Criterion Percentage

Average Equivalent
1.0 25%
1.1 24%
1.2 23%
1.3 22%
1.4 21%
1.5 20%
1.6 19%
1.7 18%
1.8 17%
1.9 16%
2.0 15%

Note: Kindly Attach your CERTIFIED TRUE COPY OF GRADES SIGNED BY THE REGISTRAR
AND THE APPLICANT AFTER THIS PAGE.

Academic Qualific

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 OFFICE OF STUDENT AFFAIRS AND SERVICES
Burgos Street, Bacolod City,
Negros Occidental, Philippines 6100
Tel. (034) 434 4561 local (123)

IV. LEADERSHIP QUALIFICATIONS

1. The student must manifest leadership skills in any of the following: the classroom,
student organization, student council, student government, other co-curricular and extra-
curricular organization of the school. Also included are organizations in the city, the
province, the region, the national level, and/or international level provided such
leadership reflects STIWNU’s interest and pride.
2. All leadership undertakings should be in the specific semesters mentioned in the general
qualifications. FOR FRESHMEN, ONLY THE FIRST SEMESTER IS CONSIDERED.

Legend:
Leadership Organization Legend Equivalent No. of Points
Classroom C 1 Point
Student Organization SO 2 Points
Student Council SC 3 Points
Student Government SG 4 Points
Co-Curricular/Extra-
CO/EC 5 Points
Curricular Organization
City C 6 Points
Province P 7 Points
Region R 8 Points
National N 9 Points
International I 10 Points

Leadership Position Equivalent No. of Points

President, Chairman, Governor, Head, or
5 Points
its equivalence
Vice President, Vice Chairman, Vice
3 Points
Governor, Vice Head, or its equivalence
Officer, Board Member, Representative, or
2 Points
its equivalence

No. Position Inclusive Years in Position Leadership Organization Reference Page

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Social Responsibilit

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 OFFICE OF STUDENT AFFAIRS AND SERVICES
Burgos Street, Bacolod City,
Negros Occidental, Philippines 6100
Tel. (034) 434 4561 local (123)

V. . ACHIEVEMENT QUALIFICATIONS
1. The student must be a co-curricular or extra-curricular achiever in any of the following levels:
Campus Organization, Department, College, and/or University. Also included are in the level of
Barangay, City, Province, Regional, National, and/or international award and citation provided
such achievement reflects STIWNU’s interest and pride.

Level of Achievement Legend Equivalent Number of Points

Campus Organization CO 1 point
Departmental D 2 points
College CL 3 points
University/Institutional U 4 points
Barangay B 5 points
City C 6 points
Province P 7 points
Regional R 8 points
National N 9 points
International I 10 points

2. The achievement in co and extra-curricular activities cited and/or awarded individually or as

part of a team or group must be manifested in the following endeavor but not limited to arts,
music and literature; sports; science and math; academic-related activities; community outreach
and extension; advocacy and volunteerism.

Level of Involvement Equivalent Number of Points

Individual 5 points
Group/ Team of 2 to 10 pax 3 points
Group/ Team of more than 10 pax 2 points

Date Level of Level of

No. Organized by Reference Page
(MM-DD-YY) Achievement Involvement
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

ACHIEVEMENT QUALIF

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 OFFICE OF STUDENT AFFAIRS AND SERVICES
Burgos Street, Bacolod City,
Negros Occidental, Philippines 6100
Tel. (034) 434 4561 local (123)

V. ADVOCACY QUALIFICATIONS
1. The student must manifest meritorious advocacy on the following but not limited to,
humanitarian act, environmental engagement, psychological welfare, spiritual guidance,
physiological wellness, and public service through the act of volunteerism and dedicated
passion.
Level of Initiatives Equivalent Number of Points
Individual 5 points
Group/ Team of 2 to 5 pax 3 points
Group/ Team of more than 5 pax 2 points

2. The student’s advocacy must affect any of the following levels: Department, College,
and/or University. Also included are in the level of Barangay, City, and Province provided
such advocacy reflects STIWNU’s interest and pride.
Level of Advocacy Legend Equivalent Number of Points
University/Institutional U 2 points
Purok PR 4 points
Barangay B 6 points
City C 8 points
Province P 10 points

Date Level of Level of

No. Beneficiary Level Reference Page
(MM-DD-YY) Initiatives Advocacy
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

ADVOCACY QUALIFI

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 OFFICE OF STUDENT AFFAIRS AND SERVICES
Burgos Street, Bacolod City,
Negros Occidental, Philippines 6100
Tel. (034) 434 4561 local (123)

VI. Supporting Documents

Insert the following after this page:

Achievement Qualifications
Shall include only photos of awards with descriptive captions (name of honor/award, date, venue, and award-
giving bodies), copies of newspaper clippings or certificates; certified true copy signed by the dean.

Leadership Qualification
Shall include only copies of certificates, newspaper clippings, photos of activities (name of activity, date, venue,
and organizing bodies), or photos of awards (for co- and extra-curricular awards); and certified true copy signed
by the dean.

Advocacy Qualification
Shall include only copies of certificates, newspaper clippings, photos of activities (name of activity, date, venue,
and organizing committees), or photos of awards (for civic involvements and services). certified true copy
signed by the dean.

NB:
- Only one (1) proof/supporting document shall be submitted for each claim
- Supporting documents should not include minutes of the organizational meetings, project evaluation reports,
thesis and feasibility studies, project proposals, general plans of actions, calendar of activities.
- For certificates and newspaper clippings, photocopied materials are preferred.

Supporting Docum

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