Humss Membership

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Republic of the Philippines

Department of Education
Region III-Central Luzon
Schools Division of Bulacan
San Miguel National High School

Humanities and Social Sciences Club (HUMSS Club)

Membership Form for Humanities and Social Sciences Club


Please Fill up this Form with Information Needed

I. Personal Information

NAME Please one letter in each box. Leave one box blank between names.

Last Name

First Name

Middle Name

Date of Birth Sex

____________/_______/_________ (__) Male (__) Female


Month Day Year
Complete /Permanent Address

___________________________________________________________________

II. Membership
1. HUMANITIES AND SOCIAL SCIENCES CLUB
Club or Organization (Please do not abbreviate) _______________________________________
2. Current Position _______________________
3. Club Adviser __________________________
ROWENA V. SAN JUAN
4. ALEXANDER L. DE LAZO
Club Co-Adviser __________________________

I certify that I am bona fide officer of San Miguel National High School. I,
whose name and other personal details are herein stated, do hereby file
Membership Form for the school year 2024-2025. I further state that I am bona fide
officer of this school with good moral character and I will abide with the school rules
and guidelines. I hereby certify that the facts stated herein are true and correct to
the best of my knowledge.

__________________________________
Signature of Officer over Printed Name
____________________________________________

_______________________________________ _______________________________________
ROWENA V. SAN JUAN ALEXANDER L. DE LAZO
Signature over Printed Name of Club Adviser Signature over Printed Name of Club Co-Adviser

Address: Scuala St., San Juan, San Miguel, Bulacan


Telephone Nos: (044) 2400-171 / (044) 2400-175
Email add: [email protected]
Republic of the Philippines
Department of Education
Region III-Central Luzon
Schools Division of Bulacan
San Miguel National High School

Membership Form for Humanities and Social Sciences Club (HUMSS Club)

Prepared by:
MELODY L. SOLIS
President

ALEXANDER L. DE LAZO ROWENA V. SAN JUAN


Co-Adviser Adviser

Checked:

BAYANI DL. PASCUAL, JR.


Subject Group Head

Noted:

JOSELITO G. MILAN, PhD CHERILYN R. GOYENA, PhD


Assistant School Principal II, OLS Assistant Principal II
OIC, JHS Academics SHS Academics

Approved:

MARCIANO V. CRUZ, JR.


School Principal IV

Address: Scuala St., San Juan, San Miguel, Bulacan


Telephone Nos: (044) 2400-171 / (044) 2400-175
Email add: [email protected]

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