NOMINATION FORM. has the distinct honor and (Nominating Organization/Institution/Individual/Company/Association) pleasure to nominate:

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1 The Chairman Search for Outstanding Alumni Alumni Affairs Office Medical Colleges of Northernrn Philippines Alimannao Hills Peñablanca, Cagayan Dear Sir / Madam: NOMINATION FORM (Date) has the distinct honor and (Nominating Organization/Institution/Individual/Company/Association) pleasure to nominate: to the Search for Outstanding Alumni Award on the occasion on the 20 th Founding Anniversary of Medical Colleges of Northern Philippines. I/ We support the nomination as follows: (Please say something to support your nomination.) Attached are the following: Duly accomplished Nomination Form. Personal Data sheet of the Nominee. Short Description of the Nominee s Outstanding Achievements (s)/ Contribution (s) in his field/ vocation. (Outline Form). Two (2) pieces 3x5 colored picture (half- body). Supporting Documents, testimonials, pictures: (Description of the Nominee s career including personal and work background especially the scope of his/ her work/ activity and his/ her resources in achieving his/ her goal.) (Description of Nominee s outstanding/ exceptional achievement(s)/ contribution(s) in his/her field/ vocation.) Respectfully, Signature over Printed Name (Official Representative of the Nominating Organization/ Institution/ Company/ Association) Telephone/ Cell Phone Number: Fax No. E- mail Address Mailing Address:

2 Rationale: The 20 th Founding Anniversary of Medical Colleges of Northern Philippines outstanding Alumni Award seek to give recognition to Mighty Eagles for their extraordinary contributions to the growth and development of the Philippines and whose achievements in their professions or vocations have substantially brought honor and prestige to the Institution. By recognizing the exemplary achievements of the Alumni, Medical Colleges of Northern Philippines seeks to hold them up for emulation by others even as it seeks to extend its appreciation for what they have done. Categories of the Awards: Nominations for the Outstanding Alumni may be made by any person or group of persons or by any organization/ institution/ company/ association/ for any and/ or several aspiring nominees who are graduates in the following courses: College of Nursing College of Radiologic Technology College of Physical Therapy Associate in Radiologic Technology Midwifery Dental Technology Guidelines and Qualifications for Nomination Must be Graduate of any Program from the Medical Colleges of Northern Philippines. Must have a good moral character. Must be recognized by his/ her peers on his/ her outstanding performance. Awards Criteria and Numerical Equivalence Awards Criteria Personal Good Moral Character ( 10) Continuing Identification with Medical Colleges of Northern Philippines. ( 10) Professional Achievements Position Held ( 7) Performance/ Achievements ( 12) Membership in Profession and Related Organizations. ( 4) Recognitions/ Awards. (10) Professional Development. (7) Community and Social Services Position Held ( 2) Standing and Reputation of organization served/ affiliated( 5) Project Undertakenn on a community/ organization level ( 10) Impact of Projects Undertaken ( 17) Recognition and awards received for service( 6) Total Points Total Numerical Equivalent 20 points 40 points 40 points 100 points

3 Procedures for Nomination Any person or group of persons or an organization/ institution/ company/ association of good standing may submit names of qualified nominee s together with all the requirements to wit; Search and Screening committee Search for Most Outstanding Alumni Alumni Affairs Office Medical Colleges of Northern Philippines Alimannao Hills Peñablanca, Cagayan Submission may also be made through Telefax number: address: mcnp15_isap11@yahoo.com Web site: All nominations shall be pre- screened by the search and screening committee as to their qualifications, merits and compliance with the basic requirements. Nominee s who shall be pre-qualified shall undergo background check for validation and confirmation of qualifications. After validations, the Search and Screening committee shall come up with the list of Final Nominee s for submission to the Selection Committee. Requirements for Nominations Duly accomplished Nomination Form. Personal Data Sheet of the Nominee. Short Description of nominee s outstanding Achievement(s)/ contribution(s) in his/her field/ vocation (outline form). Two pieces (2) 2x2 colored picture (half body). Attach supporting documents, testimonials, pictures: (Description of the Nominee s career including personal and work background especially the scope of his/ her goals). (Description of Nominee s outstanding/ exceptional achievements/ contributions in his/ her field/ vocation). Reasons or basis why the nominee should be selected as an Outstanding Alumnus/ Alumna. Schedule of Events March 01, 2013 May 31, 2013 June 28, 2013 August 30, 2013 September 30, 2013 November 29, 2013 FEBRUARY 2014 Date Event Launching Deadline of submission Preliminary screening Final Screening Selection of candidate Confirmation Awarding of Most Outstanding Alumni

4 SCREENING COMMITTE Alumni Institute Association led by their Dean REYNALDO ADDUCUL, RN, RN, MSN DEAN, College of Nursing and Two year Courses WINNIE T. CANSEJO, RRT, MPH DEAN, College of Radiologic Technology CINDY T. DULDULAO, PTRP, MPH DEAN, College Of Physical Therapy FINAL SELECTION COMMITTEE Dr. RONALD P. GUZMAN Honorary Chairman WILMA ROA-GUZMAN, RN, MAN, Ph.D. Co- chair EDNA P. CARDENAS, Ph.D. Member PRESENITA C. AGUON, Ph.D. Member CHRISTIAN R. GUZMAN, MBA Member ATTY. CRISTINA GUZMAN- NATIVIDAD Moderator

5 I. Personal Background Name: Sex: Civil Status: (First Name, Middle Name, Family Name) PERSONAL DATA SHEET OF THE NOMINEE Date of Birth: Place of Birth: Age: Name A. Husband/ Wife B. Children: Educational Attainment Achievements Address Telephone Number Mobile Number Fax Number E- mail Address Home Office Educational background Elementary Certificate Name of School/ Institution ( Address Included) Inclusive Date Honor/s Received High School Diploma College Diploma Graduate School Diploma Special Studies/ Training: Nature of Special Studies/ Training A. Local Institution/ Agency/ Organization B. Abroad (NOTE: Please attach official supporting documents.)

6 II.Professional Achievements 1. Work History: Position Held Name of Organization/ Institution/ Company/Association 2. Performance/ Achievements: 3. Membership in Professional and Related Organization: Position Held Name of professional and related organizations Accomplishments 4. Special Recognitions/ Outstanding awards received; Name of Award Sponsoring organization/ Institution/ Company/ Association 5. Scholarship Received: Title of Scholar Sponsoring organization/ Institution/ Company/ Association (NOTE: Please attach official supporting documents.)

7 6. Articles/ Publications/ Book Published: Topic/ Title Name of Publication s 7. Professional Development: III. Community and Social Services: Position Held Name organization/ Institution/ Company/ Association s Project Undertaken Impact of Project Recognition and Awards Received for Community and Social Services: Title of Recognition/ Awards Sponsoring organization/ Institution/ Company/ Association s IV. Others. (NOTE: Please attach official supporting documents.)

8 The Medical Colleges of Northern Philippines (MCNP) through its Alumni Affairs Office and Administration will conduct the Search for Outstanding Alumni Award for its 20 th Founding Anniversary. The award seek to give due recognitionn to Mighty Eagles who have provided extraordinary contribution to the growth and development of the Philippines and whose achievements in their professions or vocations have substantially brought honor and prestige to our Institution. MCNP s outstanding Alumnii award intends to honor Graduates from a variety of professional discipline and features several categories, including: College of Nursing, College of Radiologic Technology, College of Physical Therapy, Associate in Radiologic technology, Midwifery, Dental Technology. Name of qualified nominees along with complete requirements can be submitted to the Search and Screening Committee (Search for Most Outstanding Alumni), Alumni affairs Office, Medical Colleges of Northern Philippines, Alimannao Hills Penablanca, Cagyan.