8/9/2019 RQAT Nomination Form 2010

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ANNEX A Nomination Form

Republic of the PhilippinesOFFICE OF THE PRESIDENT

COMMISSION ON HIGHER EDUCATION

NOMINATION FORMRegional 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 RQATMember :

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________

Signature of theNominator

1. Name_________________________________________________________________________

8/9/2019 RQAT Nomination Form 2010

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(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 _________________________________________________