UEB Form 1

Republic of the Philippines

CENTRAL LUZON STATE UNIVERSITY
Science City of Muñoz, Nueva Ecija

UNIVERSITY ELECTORAL BOARD

Date_________________

APPLICATION FORM

The Chair
University Electoral Board
CLSU, Science City of Muñoz
Nueva Ecija

Sir:

I, __________________________________ (print name), hereby file my certificate of

candidacy for the position of ___________________________ of the University Supreme Student
Council under the ______________________________________________ Student Political Party:
that I am eligible having met the following qualifications:

1. A bonafide college student of CLSU;

2. Not in the warning list, and does not have a grade of 5.0 or more than one incomplete grade
or 4.0 during the immediately preceding semester as certified by the University Registrar.
Summer classes will be considered as the immediately preceding semester if the candidate
was enrolled during the immediately preceding summer classes; if the candidate incurred
more than one incomplete grade or 4.0 which has been completed prior to the submission of
candidacy, the candidate will still be disqualified; If the candidate received NO GRADE or IN
PROGRESS he/she must seek certification from the teacher concerned that the grade is
passed.
3. Not enrolled and shall not enroll in practice teaching or apprenticeship or field practice or
internship or its equivalent subject course during the school year 2017-2018.
4. Not graduating during the first semester of school year 2017-2018.
5. Not holding any major position (President, Vice President, Secretary, Treasurer, and Auditor)
in the USSC, any recognized organization (including college councils) or any editorial staff
position in the CLSU Collegian.
6. Must be of good moral character and has not violated the Student Code of Conduct and
Discipline.

I further state that I will support and defend the constitution of the CSBO and obey the rules
governing the Student Election (USSC) promulgated by the University Electoral Board.

Very truly yours,

______________________________
Signature of Candidate

Attested and recommended for approval:

____________________________
Signature of Standard Bearer
 UEB Form 2
APPLICANTS DATA

1. Name:_______________________________________Nickname:_____________________
2. Course/Yr.__________________Major Field of Specialization: _______________________
3. Age:________Birthdate_____________________Place:_____________________________
4. Citizenship : _________________ Civil Status:______________ Religion:_______________
5. Address: __________________________________________________________________
6. Parents/Guardian: Occupation Address
Father : _______________________ _____________________ ___________________
Mother : ______________________ _____________________ ____________________
7. Educational Background :
School Attended Inclusive Dates Honor Received
Elementary : __________________ ___________________ _____________________
High School : ___________________ ___________________ _____________________

I . Extra-Curricular Activities and Community Involvement

Membership in Org’n Position Held Inclusive Dates Scope Local/Nat’l

II. Leadership Trainings/Congress/Assembly/Conference Attended :

Title Sponsoring Agency Date Scope

III. Projects Spearheaded

Title Type of Involvement Date Scope

IV. Awards/Citations

Title Given By

V. Others (Please specify)

__________________________________
Signature of Candidate
CP # _____________________________

Note: Only one nickname is allowed.

 UEB Form 3

Republic of the Philippines

CENTRAL LUZON STATE UNIVERSITY
Science City of Muñoz, Nueva Ecija

UNIVERSITY ELECTORAL BOARD

CERTIFICATION

This is to certify that Mr. /Ms. ______________________________________ does not

hold any major position (President, Vice President, Secretary Auditor, Treasurer) in the USSC,
any recognized Student Organization, College Council, or an Editorial Staff position in the CLSU
Collegian.

Attested by : ____________________________
SOU Officer

____________________________
Adviser, College Council

____________________________
Collegian

____________________________
USSC

NOTE: Resignation letter/s must be attached/submitted with proper signature of authorized

official.
 UEB Form 4
Republic of the Philippines
CENTRAL LUZON STATE UNIVERSITY
Science City of Muñoz, Nueva Ecija

UNIVERSITY ELECTORAL BOARD

CERTIFICATE OF GOOD MORAL CHARACTER

This is to certify that ______________________________________ is a bonafide

student of the COLLEGE of _______________________________ and as per records filed in
our respective offices, has not violated any of the provisions of the CLSU CODE OF CONDUCT
and DISCIPLINE.

We therefore attested that the candidate is of good moral character.

Attested by : ____________________________
Dean of Students

____________________________
Head, Univ. Security Force

____________________________

Dean, College of ___________

Note: A photocopy of form 6 /CLSU ID must be attached.

 UEB Form 5
Republic of the Philippines
CENTRAL LUZON STATE UNIVERSITY
Science City of Muñoz, Nueva Ecija

UNIVERSITY ELECTORAL BOARD

CERTIFICATION

This is to certify that

______________________________________________

is not enrolled and shall not enroll in an Off-Campus Practice Teaching, or field practice or
Apprenticeship or internship or its equivalent subject course for the first semester and second
semester of School Year 2017-2018, and is not graduating during the first semester of School
Year 2017-2018.

Attested by : ____________________________
College Registrar

____________________________
Department Chairman
 UEB Form 6
Republic of the Philippines
CENTRAL LUZON STATE UNIVERSITY
Science City of Muñoz, Nueva Ecija

UNIVERSITY ELECTORAL BOARD

CERTIFICATION

This is to certify that Mr./Ms. _____________________________________ is not in the

warning list and does not have a grade of 5.0 or more than one incomplete grade or 4.0 during
the immediately preceding semester.

Note : Summer classes will be considered as the immediately preceding semester if the
candidate was enrolled during the summer classes.

Kindly indicate the status of the candidate:

____________________________________.

Attested by :

____________________________
University Registrar

NOTE: Attached certification of grades. The applicant must secure certification from the
concerned teacher that he/she passed the subject course if given a NO GRADE or IN
PROGRESS.