Speaker Eugenio Perez National Agricultural School

San Carlos City, Pangasinan

SUPREME STUDENT GOVERNMENT

CERTIFICATE OF CANDIDACY

S S G E L E C T I O N S 2 0 1 5

INSTRUCTIONS (Please read carefully before filling up this form):

1. Please read the Revised Standard Constitution and By-Laws of the Supreme Student

Government (DepEd Order No. 47 s.2014);

2. Print legibly, in capital letters and fill all required information. Only accomplished forms will

be processed; and

3. This certificate of candidacy shall be certified by the COMELEC and endorsed by the adviser.

I hereby announce my candidacy for the position of _____________________________ of the Speaker

Eugenio Perez National Agricultural School Supreme Student Government in the 2015 SEPNAS SSG

Elections; and do herby state the following:

1. FULL NAME: _______________________________________________________________________________

Last Name First Name Middle Name

2. ADDRESS: ___________________________________________________________________________________

3. GENERAL WEIGHTED AVERAGE (for 2nd Grading Period of the current SY): ___________________

4. YEAR and SECTION: _______________________ SPECIALIZATION: _____________________________

5. OFFICALLY NOMINATED BY: ______________________________________________________________

Political Party

6. DATE OF BIRTH (mm/dd/yy): ___________________ 7. AGE: __________ 8. GENDER: __________

9. I AM BONAFIDE STUDENT OF SPEAKER EUGENIO PEREZ NATIONAL AGRICULTURAL

SCHOOL, OF GOOD ACADEMIC STANDING AND OF GOOD MORAL CHARACTER.

10. I HAVE NOT BEEN SUBJECTED TO ANY DISCIPLINARY SANCTION AND HAVE PAID THE

SSG DEVELOPMENTAL FEE AND OTHER RELATED SSG CONTRIBUTIONS SINCE MY

ADMISSION TO THE SCHOOL.

11. I AM ELIGIBLE for the position I seek to be elected. I will support and defend the Revised

Constitution and By-Laws of the Speaker Eugenio Perez National Agricultural School Supreme

Student Government, and will maintain true faith and allegiance thereto; that I will obey all rules and

regulations promulgated by the duly constituted authorities of Speaker Eugenio Perez National

Agricultural School ; and that I impose this obligation upon my self voluntarily, with mental

reservation or purpose of evasion.

I hereby certify that the cats stated herein are true and correct of my own personal knowledge.

Date Filed: _____________________

________________________________________

Signature of Candidate over Printed Name

Contact Number: _______________________

RECEIVED and CERTIFIED by me this ______ day of January, 2015 at the SEPNAS SSG Office.

MENCHIE P. DELOS SANTOS

SSG President, SY 2014-2015

REMARKS: ____ QUALIFIED ____DISQUALIFIED

Endorsed:

ROMEO M. DOYAOEN

SSG Adviser