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Online Learning Module Writing: Application Form

This document contains an application form from Elvin Azares to participate in an online learning module writing training program. It provides his personal details like name, address, contact information and employment details as an English teacher at Osmeña Colleges. It also includes a certification from the school permitting him to attend the training from June 8 to 22, 2020 at Ateneo de Naga University. The form requests information about his internet access and bank account for providing an internet allowance during the program.

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alvin n. vedarozaga
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91 views3 pages

Online Learning Module Writing: Application Form

This document contains an application form from Elvin Azares to participate in an online learning module writing training program. It provides his personal details like name, address, contact information and employment details as an English teacher at Osmeña Colleges. It also includes a certification from the school permitting him to attend the training from June 8 to 22, 2020 at Ateneo de Naga University. The form requests information about his internet access and bank account for providing an internet allowance during the program.

Uploaded by

alvin n. vedarozaga
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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COMMISSION ON HIGHER EDUCATION

REGION V
in partnership with
BICOL FOUNDATION FOR HIGHER
EDUCATION ATENEO DE NAGA
UNIVERSITY

ONLINE LEARNING MODULE WRITING


APPLICATION FORM
(To be submitted with attachments)

Name: AZARES ELVIN GIGANTE


(LASTNAME) (FIRSTNAME) (MIDDLE NAME)
Birthday: AUGUST 29,1994 Age: 25 Gender: M Status: Single Religion: CATHOLIC Citizenship: FILIPINO
Mailing Address: PUROK 1,BRGY.MARINTOC, MOBO, MASBATE 5402
Home/ProvincialAddress: PUROK 1, BRGY. MARINTOC, MOBO, MASBATE 5402
Facebook Name/ Account: VINCE SERAZA
Tel. No.: Mobile Number/s.: 0906-281-4705 Email Address: [email protected]
Name of Sending Higher Education Institution (SHEI): OSMEÑA COLLEGES
Address: OSMEÑA STREET, CITY OF MASBATE Tel./Fax No. (056) 333-2778

With internet provider: () Yes ( ) No


If Yes, please attach/scan proof of billing.
If No, possible medium for internet connection:

For internet allowance, please indicate the following:


Bank: For MOBILE DATA For BROADBAND/ POCKET NUMBER
UCPB Mobile Number: Mobile Number:
Bank Account
Name:
ELVIN G. AZARES [ ] Globe [ ] TM [ ] Globe [ ] TM
Bank Account Number: [ ] Smart [ ] PLDT [ ] Smart [ ] PLDT
102090076044 [ ] Talk n Text [ ] Others: [ ] Talk n Text [ ] Others:

Educational Attainment: (Use additional sheet if necessary)


School Degree Obtained/Units Earned Date Graduated
Baccalaureate OSMEÑA COLLEGES BSED-ENGLISH MARCH 2019
Post-baccalaureate OSMEÑA COLLEGES MASTER OF EDUCATION/12 UNITS

Current Employment Details:


College/
Status of Employment Period Covered
Designation Department/
Full/Part Time From To
Institution
TEACHER FULL TIME OSMEÑA COLLEGES HIGH JUNE 2019 PRESENT
SCHOOL DEPRT.

Courses Taught: (Use additional sheet if necessary)


Number of Years Period Covered
HUSOCOM Courses From To
Taught
ENGLISH 7 AND 8 1 2019 2020

Other Courses
CONTEMPORARY WORLD 1 2019 2020

MR. WILFREDO M. PELIÑO JUNE 3, 2020

OFFICER-IN-CHARGE

MR. ELVIN G. AZARES JUNE 3, 2020


Osmeña Colleges
City of Masbate, 5400, Philippines
Tel/fax. (056) 333-2778
Email Address: [email protected]

CERTIFICATION

This is to certify that ELVIN G. AZARES a full-time/ part-time faculty of OSMEÑA

COLLEGES is recommended to participate in the “FAST TRACKING THE RETOOLING OF

HIGHER EDUCATION INSTITUTIONS ON FLEXIBLE LEARNING IN REGION V FOR

EDUCATION 4.0”, at the ATENEO DE NAGA UNIVERSITY starting JUNE 8, 2020 until

JUNE 22, 2020.

MR. ELVIN G. AZARES JUNE 3, 2020

(Signature over Printed Name of Faculty Trainee) Date

MR. WILFREDO M. PELIÑO JUNE 3, 2020

(Signature over Printed Name of School Head) Date

BY: MRS.ROQUESA F. DAEP


K TO 12 HEADMASTER
OFFICER-IN-CHARGE

Note: This must be submitted using the letterhead of the home/sending institution

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