DASIG Student Program

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DASIG Student Program

Full Name (First Name, Middle Initial, Family Name)* Student ID Number* Complete Home Address* Contact Number*

Senior High School Strand (example: GAS or STEM)

Upload Scanned/Picture Copy of Award Certificate

Award 1 (Indicate the Name of the Award) Upload Scanned/Picture Copy of Award Certificate Award 2 (Indicate the Name of the Award) Upload Scanned/Picture Copy of Award Certificate Award 3 (Indicate the Name of the Award) Upload Scanned/Picture Copy of Award Certificate Award 4 (Indicate the Name of the Award) Upload Scanned/Picture Copy of Award Certificate

Affiliated Organization

Indicate the Name of your School/Community Organization

Affiliated Organization 1 Your Position in the Organization (Example: President or Member) Affiliated Organization 2 Your Position in the Organization (Example: President or Member) Affiliated Organization 3 Your Position in the Organization (Example: President or Member)

Community Service Activity

Indicate the Name/Title of the Activity and the Organizer

Service Activity 1 Upload Scanned/Picture Copy of Certificate of Participation or ang evidence of Participation Service Activity 2 Upload Scanned/Picture Copy of Certificate of Participation or ang evidence of Participation We value and protect your personal information in compliance with the Data Privacy Act (R.A. 10173). The information you share here will be stored in a database accessible to JCI Cebu and its Board of Directors only. These will be used to serve as references for preparing certificates, for future planning, and for communication, among others. The contact details (mobile nos., e-mail addresses, and residential address) you will provide shall be used for our official communications with you. I agree with the PRIVACY NOTICE

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DASIG Student Program

Senior High School Strand (example: GAS or STEM)

Upload Scanned/Picture Copy of Award Certificate

Affiliated Organization

Indicate the Name of your School/Community Organization

Community Service Activity

Indicate the Name/Title of the Activity and the Organizer

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