Alumni Family Loyalty Award

2016 BSU CENTENNIAL YEAR SEARCH FOR OUTSTANDING ALUMNI NOMINATION FORM ALUMNI FAMILY LOYALTY AWARD (An alumni whose children (all, at least 5) studied at BSU from elementary to college)

Name of Nominee: Family Name First Name Middle Name Degree and Year graduated: Pls. check: ( )TAS, ( )TNAS, ( )MNAS, ( )MNAC, ( )MAC ( )MSAC, ( )BSU Home Address: Contact No.: Email address: Conforme: I attest that the information given are true and correct, and I agree to this nomination. I also agree to personally receive the award during the awarding ceremony on September 27, 2017 at BSU if selected.

Name and Signature of at least one member of the family

Name Name of Degree and Year Graduated Elementary High School College Parent(s) (at least one):

Children (at least five): 1. 2. 3. 4. 5. 6. 7.

Submit the following: 1. Nomination Form 2. List of achievements/contributions to the community (not more than 2 pages), and recognition awards (title of award, awarding organization, place and year) if any. 3. Individual photo of children or family if any attached to the nomination form.

Note: Submit all the required documents on or before June 30, 2017 to: The Chairman, 2016 BSUCentennial Search for Outstanding Alumni BSUAAI Office, BSU Alumni Center, BSU Cpd. Betag, La Trinidad, Benguet 2601, Philippines. Tel. No. (063)(74)309-3878 or 09088647520 Email address: [email protected] or [email protected]

The Nominator: This is to certify that that the entries are true and correct to the best of my knowledge. Name and Signature: Degree and year graduated from BSU: Contact number: Email address: Date submitted:

(This form can be reproduced)

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2016 BSU CENTENNIAL YEAR SEARCH FOR OUTSTANDING ALUMNI

NOMINATION FORM MULTI-GENERATION ALUMNI FAMILY AWARD (An alumni with at least 3 generations of children that studied at BSU)

Name of Nominee: Family Name First Name Middle Name Degree and Year graduated: Pls. check: ( )TAS, ( )TNAS, ( )MNAS, ( )MNAC, ( )MAC ( )MSAC, ( )BSU Home Address: Contact No.: Email address: Conforme: I attest that the information given are true and correct and I also agree to this nomination. I also agree to personally receive the award during the awarding ceremony on September 27, 2017 at BSU if selected.

Name and Signature of at least one member of the family

Name of Degree and Year Graduated Name Elementary High School College Grand Parent(s)(at least one):

Parent(s)(at least one):

Child(ren) (at least one): 1. 2. 3. Grand Child(ren)(at least one): 1. 2. 3.

Submit the following: 1. Nomination Form 2. List of achievements/contributions to the community (not more than 2 pages), and list of recognition awards (title of award, awarding organization, place and year) if any. 3. Individual photo of child(ren)or family if any attached to the nomination form.

Note: Submit all the required documents on or before June 30, 2017 to: The Chairman, 2016 BSU Centennial Search for Outstanding Alumni BSUAAI Office, BSU Alumni Center, BSU Cpd. Betag, La Trinidad, Benguet 2601, Philippines. Tel. No. (063)(74)309-3878 or 09088647520 Email address: [email protected] or [email protected]

The Nominator: This is to certify that that the entries are true and correct to the best of my knowledge. Name and Signature: Degree and Year graduated from the school: Contact Number: Email address: Date submitted:

(This form can be reproduced} 2016 BSU CENTENNIAL YEAR SEARCH FOR OUTSTANDING ALUMNI

NOMINATION FORM DISTINGUISHED ALUMNI

Name of Nominee: Family Name First Name Middle Name Degree and Year graduated: Pls. check: ( )TAS, ( )TNAS, ( )MNAS, ( )MNAC, ( )MAC ( )MSAC, ( )BSU Home Address: Contact No.: Email address: Conforme: I attest that the information given are true and correct, and I agree to this nomination. I further agree to personally receive the award during the awarding ceremony on September 27, 2017 at BSU if selected.

Signature of Nominee

Submit the following: 1. Duly accomplished Nomination Form. 2. Brief description of the nominees’ qualifications highlighting outstanding achievements deserving of recognition (not more than 2 pages) over the span of their entire career (25 year or more). The Distinguished Alumni should have demonstrated extra ordinary professional success and achievement and has brought the name of the university in the national level that addressed contemporary issues but not limited to community development, science and technology, governance, peace and order, enterprise development. For distinguished alumni in their field of profession, the nominee should exemplify the ideals/mission of their college/institute. 3. Updated curriculum vitae with attached three latest ID photo (2.5” x 2.5”, white background).

Note: Submit all the required documents on or before June 30, 2017 to: The Chairman, 2016 BSU Centennial Search for Outstanding Alumni BSUAAI Office, BSU Alumni Center, BSU Cpd. Betag, La Trinidad, Benguet 2601, Philippines. Tel. No. (063)(74)309-3878 or 09088647520; Email address: [email protected] or [email protected]

The Nominator: This is to certify that that the entries are true and correct to the best of my knowledge.

Name and Signature: Degree and Year graduated from BSU: Contact Number: Email address: Date submitted:

NOMINATION FORM MOST DISTINGUISHED ALUMNI

Name of Nominee: Family Name First Name Middle Name Degree and Year graduated: Pls. check: ( )TAS, ( )TNAS, ( )MNAS, ( )MNAC, ( )MAC ( )MSAC, ( )BSU Home Address: Contact No.: Email address: Conforme: I attest that the information given are true and correct, and I agree to this nomination. I further agree to personally receive the award during the awarding ceremony on September 27, 2017 at BSU if selected.

Submit the following: 1. Duly accomplished Nomination Form. 2. Brief description of the nominees’ qualifications highlighting outstanding achievements deserving of recognition (not more than 2 pages) over the span of their entire career (25 year or more). The Most Distinguished Alumni nominee should have demonstrated extra ordinary professional success and achievement and has brought the name of the university in the international community. 3. Updated curriculum vitae with attached three latest ID photo (2.5” x 2.5”, white background).

Note: Submit all the required documents on or before June 30, 2017 to: The Chairman, 2016 BSU Centennial Search for Outstanding Alumni BSUAAI Office, BSU Alumni Center, BSU Cpd. Betag, La Trinidad, Benguet 2601, Philippines. Tel. No. (063)(74)309-3878 or 09088647520; Email address: [email protected] or [email protected]

Name and Signature: Degree and Year graduated from BSU: Contact Number: Email address: Date submitted:

NOMINATION FORM FOR SPECIAL AWARD COMMUNITY SERVICE

Name of Nominee: Family Name First Name Middle Name Address: Contact No.: ______Email address: ______Conforme: I attest that the information given are true and correct and I agree to this nomination. I further agree to personally receive the award during the awarding ceremony on September 27, 2017 at BSU if selected.

Submit the following: 1. Duly accomplished Nomination Form. 2. Brief description of the nominees’ qualifications highlighting outstanding achievements deserving of recognition (not more than 2 pages) over the span of their entire career (25 or more years). The Community Service Award is given to individual alumni in far flung areas with exceptional service to the community but has remained unrecognized. 3. Curriculum vitae with attached three latest ID photo (2.5” x 2.5”, white background) including photographs of his/her activities if any.

Note: Submit all the required documents on or before June 30, 2017 to: The Chairman, 2016 BSU Centennial Search for Outstanding Alumni BSUAAI Office, BSU Alumni Center, BSU Cpd. Betag, La Trinidad, Benguet 2601, Philippines. Tel. No. (063)(74)309-3878 or 09088647520 Email address: [email protected] or [email protected]

Name and Signature : Degree and Year graduated from BSU: Contact number: Email address: Date submitted:

NOMINATION FORM FOR SPECIAL AWARD ALUMNI GROUP SERVICE

Name of Association: Office Address: Contact No.: Email address: Conforme: I attest that the information given are true and correct and I agree to this nomination. I further agree to personally receive the award during the awarding ceremony on September 27, 2017 at BSU if selected.

Name and Signature of President

Submit the following: 4. Duly accomplished Nomination Form. 5. Brief description of the nominees’ qualifications highlighting outstanding contribution to the university deserving of recognition (not more than 2 pages) within the span of at least 10 or more years). The award is given to recognized alumni association with set of officers. 6. At least one photographs of the outstanding activities of the association in the university.

Note: Submit all the required documents on or before June 30, 2017 to: The Chairman, 2016 BSUCentennial Search for Outstanding Alumni BSUAAI Office, BSU Alumni Center, BSU Cpd. Betag, La Trinidad, Benguet 2601, Philippines. Tel. No. (063)(74)309-3878 or 09088647520 Email address: [email protected] or [email protected]

Name and Signature : Degree and Year graduated from BSU: Contact number: Email address: Date submitted:

2016 BSU CENTENIAL YEAR SEARCH FOR OUTSTANDING ALUMNI

NOMINATION FORM FOR SPECIAL AWARD OLDEST SURVIVING ALUMNI

Name of Nominee: Family Name First Name Middle Name Home Address: Contact No.: Email address:

Conforme: I attest that the information given are true and correct and I agree to this nomination. I further agree to personally receive the award during the awarding ceremony on September 27, 2017 at BSU if selected.

Submit the following: 1. Duly accomplished Nomination Form. 2. Brief description of the achievement/activities highlighting his/her outstanding contributions to the community. 3. Attached three latest ID photo (2.5” x 2.5”, white background) including photographs while at BSU if any. 4. Official birth certificate and/or proof of authenticity birth date.

Note: Submit all the required documents on or before June 30, 2017 to: The Chairman, 2016 BSU Centennial Search for Outstanding Alumni BSUAAI Office, BSU Alumni Center, BSU Cpd. Betag, La Trinidad, Benguet. Tel. No. (063)(74)309-3878 or 09088647520 Email address: [email protected] or [email protected]

Name and Signature: Degree and Year graduated from BSU: Contact number: Email address: Date submitted: