Professional Documents
Culture Documents
Date_________________
APPLICATION FORM
The Chair
University Electoral Board
CLSU, Science City of Muñoz
Nueva Ecija
Sir:
I further state that I will support and defend the constitution of the CSBO and obey the rules
governing the Student Election (USSC) promulgated by the University Electoral Board.
______________________________
Signature of Candidate
____________________________
Signature of Standard Bearer
UEB Form 2
APPLICANTS DATA
1. Name:_______________________________________Nickname:_____________________
2. Course/Yr.__________________Major Field of Specialization: _______________________
3. Age:________Birthdate_____________________Place:_____________________________
4. Citizenship : _________________ Civil Status:______________ Religion:_______________
5. Address: __________________________________________________________________
6. Parents/Guardian: Occupation Address
Father : _______________________ _____________________ ___________________
Mother : ______________________ _____________________ ____________________
7. Educational Background :
School Attended Inclusive Dates Honor Received
Elementary : __________________ ___________________ _____________________
High School : ___________________ ___________________ _____________________
IV. Awards/Citations
Title Given By
__________________________________
Signature of Candidate
CP # _____________________________
CERTIFICATION
Attested by : ____________________________
SOU Officer
____________________________
Adviser, College Council
____________________________
Collegian
____________________________
USSC
Attested by : ____________________________
Dean of Students
____________________________
Head, Univ. Security Force
____________________________
CERTIFICATION
______________________________________________
is not enrolled and shall not enroll in an Off-Campus Practice Teaching, or field practice or
Apprenticeship or internship or its equivalent subject course for the first semester and second
semester of School Year 2017-2018, and is not graduating during the first semester of School
Year 2017-2018.
Attested by : ____________________________
College Registrar
____________________________
Department Chairman
UEB Form 6
Republic of the Philippines
CENTRAL LUZON STATE UNIVERSITY
Science City of Muñoz, Nueva Ecija
CERTIFICATION
Note : Summer classes will be considered as the immediately preceding semester if the
candidate was enrolled during the summer classes.
Attested by :
____________________________
University Registrar
NOTE: Attached certification of grades. The applicant must secure certification from the
concerned teacher that he/she passed the subject course if given a NO GRADE or IN
PROGRESS.