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
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