This document is an application form for a scholarship program. It requests information such as the applicant's name, contact details, parents' contact details, extracurricular activities, interests and skills. The applicant is asked to describe their social involvement and rate their time commitment to extracurricular activities. It provides a deadline to submit the application and lists the officers of the program.

1. AKSyon.ISkolar APPLICATION FORM SY 2010-2011
NAME: ____________________________________________ YEAR AND SECTION: _____________________
GENDER: _________ AGE : ______ DATE OF BIRTH: _______________________ INTERN / EXTERN (encircle)
EMAIL: _____________________________ YM ID: ___________________ BLOG (if applicable): ____________________
CONTACT NOS. (CELLPHONE AND LANDLINE): ____________________________________________________________
CITY ADDRESS: _________________________________________________________________________________________
PROVINCIAL ADDRESS (if applicable): ____________________________________________________________________
FATHER’S NAME: ____________________________ CELLPHONE NO.: ________________ CURRENT JOB: ____________
MOTHER’S NAME: ___________________________ CELLPHONE NO.: ________________ CURRENT JOB: ____________
GUARDIAN’S NAME (if not currently under the care of either parent): ______________________________________
RELATION TO STUDENT: _____________ADDRESS: _______________________________CONTACT NO.: _____________
Parent/s or Guardian’s Name(s) and Signature(s): __________________________________________
EXTRACURRICULAR ACTIVITIES AND CLUBS:
DESCRIPTION OF ACTIVITY OR NAME OF CLUB DURATION OF MEMBERSHIP RATE THE TIME AND EFFORT YOU ORDER IN YOUR
DEVOTE TO IT (10 - HIGHEST) PRIORITIES
SOCIAL INVOLVEMENT SINCE YOU STARTED HIGH SCHOOL (leadership positions held, outreach participations, involvement in
advocacy groups, etc.) :
DESCRIPTION OF ACTIVITY/POSITION HELD SPONSOR GROUP OR CLUB DURATION OF PARTICIPATION
INTERESTS AND SKILLS INDEX. In the box beside each item, write A if you can contribute ideas to that activity, B if you can
contribute your time and effort to that activity, C if you can contribute both, and LEAVE BLANK if neither.
Fund raising Designing, hosting a program
Educating others about issues and events Managing a student organization
Giving your opinion on an important issue Designing, running a website
Creating an audio video presentation Delivering an audio video presentation
Conducting an outreach activity Organizing a field trip or exposure trip
Conducting an open forum Organizing a forum, talk or speaker visit
Soliciting business sponsors Negotiating with faculty, staff or admin
Linking up with groups (clubs, batches) inside school Linking up with groups outside school
Recruiting new members Keeping members active and participative
Please submit on or before July 2, 2010 to any AKSIS officer. You will be notified for further details. Thank you. 
President: Sarah Yangco (IV-Tau). Vice President: Paul Diaz (IV-Charm). Secretary: Joan Ravalo (III-Rb). Treasurer: Golda Labalan (IV-Muon). Auditor: Thea Bonficio
(III-Na). Others: Carlos Chanyungco (IV-Charm), Paul Vocal (IV-Gluon), Desi Mina (IV-Gluon), Ryan Misola (III-Cs)