NOMINATION FORM
The Chairman
____________________
(Date)
Search for Outstanding Alumni
Alumni Affairs Office
Medical Colleges of Northern Philippines
Alimannao Hills Peñablanca,
ablanca, C
Cagayan
Dear Sir / Madam:
________________________________________________
_____________________________________________________
_____ has the distinct honor and
(Nominating Organization/Institution/Individual/Company/
Organization/Institution/Individual/Company/Association)
pleasure to nominate: _____________________________________ to the “Search for Outstanding
Alumni Award” on the occasion on the 20th 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
(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 an
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/
Org
Institution/ Company/ Association)
Association
Telephone/ Cell Phone Number: _______________
_
Fax No.___________________________________
E- mail Address_____________________________
Mailing Address:
s: ____________________________
!
Rationale:
The 20th Founding Anniversary
nniversary 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 off 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
courses:
College of Nursing
College of Radiologic Technology
College of Physical Therapy
Associate in Radiologic TTechnology
Midwifery
Dental Technology
Guidelines and Qualifications for Nomination
Must be Graduate of any Program from the Medical C
Colleges
olleges 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.
wards. (10)
Professional Development. (7)
Community and Social Services
Position Held ( 2)
Standing and Reputation of organization
served/ affiliated( 5)
Project Undertaken 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
!
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: 078-3041010
E-mail address: [email protected]
Web site: www.mcnpisap.com
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
!
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
!
PERSONAL DATA SHEET OF THE NOMINEE
I. Personal Background
Name: _________________________________ Sex: ______________ Civil Status: ____________
(First Name, Middle Name, Family Name)
Date of Birth: ___________________________ Place of Birth: ___________________ Age: _______
Name
A. Husband/ Wife
B. Children:
Address
Telephone Number
Mobile Number
Fax Number
E- mail Address
Educational background
Elementary Certificate
Educational Attainment
Achievements
Home
Office
Name of School/ Institution
( Address Included)
Inclusive
Date
Honor/s Received
High School Diploma
College Diploma
Graduate School Diploma
(Please use additional sheet if needed)
Special Studies/ Training:
Nature of Special Studies/ Training
A. Local
Institution/ Agency/ Organization
Inclusive Date
B. Abroad
(Please use additional sheet if needed)
(NOTE: Please attach official supporting documents.)
!
II.Professional Achievements
1. Work History:
Position Held
Name of Organization/ Institution/
Company/Association
Inclusive Date
(Please use additional sheet if needed)
2. Performance/ Achievements:
(Please use additional sheet if needed)
3. Membership in Professional and Related Organization:
Position Held
Name of professional and related
organizations
Inclusive Date
Accomplishments
(Please use additional sheet if needed)
4. Special Recognitions/ Outstanding awards received;
Name of Award
Sponsoring organization/ Institution/
Company/ Association
Inclusive Date
(Please use additional sheet if needed)
5. Scholarship Received:
Title of Scholar
Sponsoring organization/ Institution/
Company/ Association
Inclusive Date
(Please use additional sheet if needed)
(NOTE: Please attach official supporting documents.)
!
6. Articles/ Publications/ Book Published:
Topic/ Title
Name of Publication
Inclusive Dates
(Please use additional sheet if needed)
7. Professional Development:
(Please use additional sheet if needed)
III. Community and Social Services:
Position Held
Name organization/
Institution/ Company/
Association
Inclusive Dates
Project Undertaken
Impact of
Project
(Please use additional sheet if needed)
Recognition and Awards Received for Community and Social Services:
Title of Recognition/ Awards
Sponsoring organization/ Institution/ Company/
Association
Inclusive Dates
(Please use additional sheet if needed)
IV. Others………….
(NOTE: Please attach official supporting documents.)
!
The Medical Colleges of Northern Philippines (MCNP) through its Alumni Affair
Affairs Office and Administration
th
will conduct the “Search for Outstanding Alumni Award
Award” for its 20 Founding Anniversary. The award
seek to give due recognition 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
nor and prestige to our Institution.
MCNP’s outstanding Alumni award intends to honor Graduates from a variety of professional discipline and
features several categories, including: College of Nursing
Nursing, College of Radiologic Technology,
Technology College of
Physical Therapy, Associate in Radiologic technology
technology, Midwifery, Dental Technology.
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, Me
Medical Colleges of
Northern Philippines, Alimannao Hills Penablanca, Cagyan
Cagyan.
!