ANNEX A – Nomination Form

Republic of the Philippines

OFFICE OF THE PRESIDENT
COMMISSION ON HIGHER EDUCATION

NOMINATION FORM
Regional Quality Assessment Team (RQAT)

A. Personal Information of the NOMINEE:

1. Name
_________________________________________________________________________
(Family) ( First Name)
(Middle Initital)
2. Present Job Position
______________________________________________________________
3. Name of Organization /Agency:
____________________________________________________
4. Office Address
__________________________________________________________________
5. Contact Details:
5.1. Telephone number (Office) ____________________ 5.2. Fax No.
___________________
5.3. Mobile Number _________________________________
5.4. Email Address ______________________________________________
B. To be accomplished by the NOMINATOR:

Briefly explain why you are nominating the above named person as CHED RQAT
Member :
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

__________________________

Signature of the
Nominator

1. Name
_________________________________________________________________________
 (Family) First Name) (Middle Initital)
2. Present Job Position
______________________________________________________________
3. Name of Organization /Agency:
____________________________________________________
4. Office Address
__________________________________________________________________
5. Contact Details:
5.1. Telephone number (Office) _______________________ 5.2. Fax No.
________________
5.3 Email Address _________________________________________________