APPLICATION FOR RECOGNITION/RENEWAL______ Semester, SY 20___ - 20___

Recognition : ☐ Date Filed: Renewal : ☐I. Basic Information

President/s: Adviser/s: College/Unit: Date Established: No. of Members:

2nd Year No. Of Males 3rd Year No. of Females 4th Year 5th Year 6th Year TOTAL

II. Organizational Objectives

III. Activities Performed - Preceding School Year(For Renewing Organization Only)

Date Title of ActivityClients/ Total

Number Of Attendees

Type of Activity

(Use additional sheet, if necessary)

I hereby certify that all information stated herein are true and correct to the best of my knowledge and belief as President of the organization. I pledge to abide by the policies and rules of the organizations.

____________________________President/Head

Attested by:

____________________________Adviser/s

ACA.OSA.SOU.F.001 (Revision No. 0; August 31, 2016)

Republic of the PhilippinesCENTRAL LUZON STATE UNIVERSITY

Science City of Muñoz, Nueva Ecija

OFFICE OF STUDENT AFFAIRSStudent Organizations Unit