/ 12th NATIONAL YOUTH PARLIAMENT
21-25 October 2018
Davao City
APPLICATION FORM /
Province:
Print legibly. Shade appropriate “Ο”.
I. PERSONAL INFORMATION
Name: ______
Family Name Given Name Middle Name
Date of Birth: / dd/mm/yyyy / Age: / Sex: / Ο Male
Ο Female
Permanent Address:
Residential Address:
Contact Details:
(Mandatory to FiRl requiredl) / E-mail Address:
Mobile Number: / CATEGORY OF DELEGATES (Please shade all applicable)
Ο In- School Youth
Ο Out-of-School Youth
Ο Working Youth
Ο Specific Youth Groups / Youth with Special Needs*
Ο SangguniangKabataan
Facebook Account URL:
Food Restrictions:
II. EDUCATIONAL BACKGROUND
Name of School / University / College / Inclusive Dates / Highest Education Attainment
Junior High School:
Senior High School:
College:
Vocational:
Post-Graduate:
III. CURRENT ORGANIZATIONAL MEMBERSHIP (Please attach additional sheet if necessary)
Organization** / Inclusive Dates / Position Held
**If a member or officials of the SangguniangKabataan, please indicate position and barangay name.
IV. INVOLVEMENT IN YOUTH/COMMUNITY RELATED ACTIVITIESCOMMUNITY PROGRAMS ATTENDED
(Please attach additional sheet if necessary)
Inclusive Dates / Description

youth with disabilities, youth with indigenous background, youth of OFWs, transnational youth, youth coming from LGBTQ groups, victims of any kind of abused, neglected, trafficking, and addiction

V. NYC PROGRAMS OR ACTIVITIES PROJECTS INVOLVEMENTATTENDED
Have you been involved in any NYC programs or activities? / Ο Yes Ο No
If yes, please provide the details below. Please attach additional sheet if necessary.
Name of NYC Program or Activity / Inclusive Date / No. of Hours / Involvement/Role
Have you joined or attended any previous National Youth Parliament? / Ο Yes Ο No
VI. MORAL CHARACTER REFERENCES
NAMEHave you ever been convicted of any crime involving moral turpitude? / DESIGNATIONDo you have any pending case(s) in court? / CONTACT NUMBERΟ Yes Ο No
Ο Yes Ο No
VII. COMMITTEE MEMBERSHIP
Please rank from 1 to 9 according to your priority PYDP centers of participation, where 1 is the highest priority
Health / Governance
Education / Active Citizenship
Economic Empowerment / Peace Building and Security
Social Inclusion and Equity / Environment
Global Mobility
Note: Committee is based on your ranking and availability of slots per Center
PARENTAL/GUARDIAN’S CONSENT
(for applicants below 18 years old)
I, ______, mother, father, legal guardian of Ms./Mr.______do hereby understand and that I have read the information provided above and decided to allow my child to participate.
______
Signature over printed name
CERTIFICATION
I hereby certify upon my honor that all facts and information indicated herein are true and correct to the best of my knowledge. I further declare that any information given by me that is untrue may constitute a ground for expulsion in the 12th National Youth Parliament and prosecution for perjury.
Further, I subscribe and agree that the National Youth Commission has the sole prerogative to select, reclassify and nominate the delegates to the 12th NYP, and its decision is final and executory.
I hereby commit myself to be available from October 21-25, 2018, and to actively participate in the post-parliament activities for the next 2 years.
I expressly authorize the National Youth Commission or its representatives to use, share and process personal information that I have provided, shared or declared in this form/document/site for any lawful purpose.
I am willing to shoulder my transportation/travelling expenses necessary to facilitate my participation to the activity.
IN WITNESS hereof, I am executing and signing this statement voluntarily without compulsion.
______
Date accomplished Signature of applicant
/ 12th NATIONAL YOUTH PARLIAMENT
21-25 October 2018
Davao City
Name
Region
List down the committee of your choice Youth Issue
Identify the committies/issues and concerns; Identify the government interventions (laws, policies and programs) to address the issues and concerns; Identify the gaps/shortcomings of the laws, policies and programs implemented by the government? What are your recommendations?
Identify the committies/issues and concers; Identify the government interventions (laws, policies and programs) to address the issues and concerns; Identify the gaps/shortcomings of the laws, policies and programs implemented by the government?a specific issue affecting the youth in yout locality and provide recommendations that will address said issue.What are your recommedations.
Important: Limit your answer to 150-300 words.

REMINDERS

QUALIFICATIONS OF APPLICANTS / APPLICATION REQUIREMENTS
  1. Must be a Filipino Citizen
  2. Must be 15-30 years old on the day of the Parliament
  3. Of good moral character
  4. Able to read and write
  5. Has not been convicted of any crime involving moral turpitude
  6. Must not have been a previous National Youth Parliament delegate
/
  1. Accomplished 12th NYP Application Form
  2. Essay: 150 to 300 words
  3. Copy of any Proof of Residence and Age (Any valid IDs or document that indicates address and date of birth):
  4. School ID or Company ID
  5. Any Government Issued IDs: Postal ID, GSIS, PhilHealth, Pag-Ibig, TIN, etc.
  6. Passport
  7. Birth Certificate
  8. Must be willing to shoulder his/her travelling expenses

APPLICATION PROCESS
  1. Applications for the 12th NYP may be hand-carried, mailed or emailed to the National Youth Commission.
  2. The deadline for submission of complete documents is on July 27, 2018 (Friday) at 5:00 PM.
  3. For hand-carried or mailed applications, they may be submitted not later than the set deadline to any of the following NYC Offices:
12th NYP Screening and Selection Committee
National Youth Commission Central Office
3F West Insula Bldg., West Avenue corner EDSA,
Quezon City12th NYP Screening and Selection Committee
National Youth Commission
3F West Insula Bldg., West Avenue corner EDSA, Quezon City / National Youth Commission Baguio
Room 3 Lindi Hotel #12 Legarda Road,
Baguio CityARMANDO V. ANGELES
National Youth Commission
Room 3 Lindi Hotel #12 Legarda Road, Baguio City
National Youth Commission Naga
Ground Floor, Naga City Youth Center Bldg, Taal corner Magsaysay Ave, Naga CityNYDIA P. DELFIN
National Youth Commission
Ground Floor, Naga City Youth Center Bldg, Taal corner Magsaysay Ave, Naga City / National Youth Commission Cebu
5/F BF Building, N. Escario St. Cebu CitySHERIDAN ATHENA Y. GAJETE
National Youth Commission
5/F BF Building, N. Escario St. Cebu City
National Youth Commission Iloilo
Ground Floor, ME Bldg, Dungon B. Jaro, Iloilo CityKREYZL JOYCE PUGNA
National Youth Commission
Ground Floor, ME Bldg, Dungon B. Jaro, Iloilo City / National Youth Commission Cagayan de Oro
2/F, Cebu CFI Community Cooperative Bldg, Tiano Bros. cor. Mabini Sts.,
Cagayan De Oro CityEVANESA Q. PASAMBA
National Youth Commission
2/F, Cebu CFI Community Cooperative Bldg, Tiano Bros. cor. Mabini Sts., Cagayan De Oro City
National Youth Commission Davao
Door 1, Fuentes Bldg Quirino Ave., Davao CityJULIUS D. GUTIERREZ
National Youth Commission
Door 1, Fuentes Bldg Quirino Ave., Davao City / National Youth Commission Zamboanga
3/F VHW Bldg (Landbank) Veterans Ave., Zamboanga CityRAYMOND B. DOMINGO
National Youth Commission
3/F VHW Bldg (Landbank) Veterans Ave., Zamboanga City
  1. For submission through mail, the NYP Secretariat/Cluster/Area Offices should receive the requirements post marked on or before the set deadline.
  2. Application documents, together with the scanned requirements may be submitted online to on or before the set deadline.
E-mails must contain the following Subject format:
[Region, Province/Highly Urbanized City – Last Name, First Name Middle Initial]
Example: Region I, Ilocos Norte – Dela Cruz, Juan A
Applicants with incomplete requirements by 5:00 pm on the set deadline shall automatically be disqualified.

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