DESIGNATION FORM

Name of Organization:

Address of Organization (if applicable):

YORP Unique Registration:

Head of Organization:

Contact Number: E-mail Address:

Core Advocacy (Tick only one):

Active Citizenship Economic Empowerment Education

Environment Global Mobility Governance
Health Peace and Building and Security Social Inclusion and Equity

To whom it may concern:

This is to designate Mr./Ms. ___________________________________________________________ of

(name)
___________________________________________ to be the ALTERNATE REPRESENTATIVE for the
(name of organization)

City/Municipality/Provincial Youth Development Council.

This is to further certify that he/she has met the following qualifications:

a) a citizen of the Philippines;

b) a resident of the province, city, or municipality for not less than one year immediately
asdpreceding the day of her/his election to the LYDC;

c) should be at least fifteen (15) years, but not more than thirty (30) years of age [thirty (30) years
asdand zero (0) day old] on the day of her/his election at the LYDC:

d) able to read and write Filipino, English, or the local dialect; and

e) must not have been convicted by final judgement of any crime involving moral turpitude.

______________________________ ______________________________
Signature Over Printed Name of the Signature Over Printed Name of the
Primary Representative Head of Organization

Date Signed: ___________________ Date Signed: ___________________