Office of Student Affairs and Services

Burgos Street, Bacolod City,

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

7th UNIVERSITY HONORS DAY

SCHOOL YEAR 2022-2023

APPLICATION FORM
NON-ACADEMIC STUDENT AWARDS
Special Student Award

IMPORTANT: READ FIRST THE GENERAL AND SPECIFIC QUALIFICATIONS OF THE

AWARD. ONE APPLICATION FORM PER AWARD. ONLY SIGNIFICANT SUPPORTING
DOCUMENTS THAT APPLY TO THE AWARD ARE CONSIDERED FOR DELIBERATION AND
SELECTION.

Date: _________________________ Date of Submission: On or before May 29, 2023, 5PM

I am applying for the MOST OUTSTANDING STUDENT _____________________________________

(Culture and the Arts, Sports, or Loyalty)

NAME:
______________________________________________________________________________________
(LAST) (FIRST) (M.I.)

COLLEGE: _____________________________________ COURSE/DEGREE:______________________

AGE: _________ BIRTHDATE: ____________________ BIRTHPLACE: ________________________

Contact NO./Cell Phone: _____________________ E-Mail Address: ______________________________

Bacolod Residence Address: ________________________________________________________________

___________________________________________________ Telephone No. _________________________

Hometown Address (if different from Bacolod Residence): _______________________________________

_____________________________________________________ Telephone No. _______________________

I hereby declare that all the facts written in this application form are true and all the documents attached
are authentic or true copies from the original documents. I further submit myself to the decision of the
selection committee organized in the college/office level as well as the University. I am also willing to face
the selection committee should my presence be summoned.

_______________________________________________
Student Applicant
REQUIRED ATTACHMENTS:

Required Documents
Certificate of Good Moral Character
Bid Book (long-sized clear book)
Supporting documents include:
1. All activities participated relevant to award
2. All achievements received relevant to award