Revised as of September 26, 2019
CACR (COACH /ASST.COACH RECORD)
CAR
Region
ABRA
Division
Latest 1½ x 1½ picture
A. PERSONAL DATA:
Name: PACIS VICENTE NEIL III B.
(Last) (First) (M.I.)
Sex: MALE Mobile Phone Number: 0955-599-7695
Date of Birth: (mm/dd/yy) 4/13/1993 Age: 26 Place of Birth: BANGUED, ABRA
School: ASIST - BANGUED CAMPUS Employee Number:
Current Position: INSTRUCTOR I Years in Service: 5 YEARS
Address of School: ZONE 3, BANGUED, ABRA
Present Address: MONGGOC, PIDIGAN, ABRA
In Case of Emergency
Please Contact: DAPHNE CHARMAINE PACIS Contact Number: 9552232497
B. Educational Qualifications:
Course (College/Post
School Year Graduated Credits Earned Awards Received
Graduate)
MAED EM UNIVERSITY OF THE NORTH ON GOING
C. Sports Training Attended for the last three (3) years
Title of Sports Training Date of Training No. of Hours Conducted by
SPORTS CLINIC OCT. 18-20, 2019 24 DepEd Abra
D. Sports Track Record/Experience
Athletic Meet Attended Inclusive Dates Event Awards Received
CARAA MEET FEB. 27 TO MARCH 3, 2019 TABLE TENNIS GOLD
PALARONG PAMBANSA TABLE TENNIS GOLD
Prepared by: Attested by: Verified by:
VICENTE NEIL B. PACIS III
(Coach /Asst. Coach Signature over Printed Name) (Division Sports Officer Signature over Printed Name) (Division AO/SDS Signature over Printed Name)
Screened by:
Division Meet Regional Meet Palarong Pambansa
(Signature of DSAC over Printed Name) (Signature of RSAC over Printed Name) (Signature of NSAC over Printed Name)
Date: ______________ Date: ______________ Date: ______________
FOR SCHOOL SPORTS (Division, Region, Palarong Pambansa)
CACR (COACH /ASST.COACH RECORD)
CAR
Region
ABRA
Division
Latest 1½ x 1½ picture
A. PERSONAL DATA:
Name: CORPUZ MAR JOY M.
(Last) (First) (M.I.)
Sex: FEMALE Mobile Phone Number: 9355844685
Date of Birth: (mm/dd/yy) 7/11/1992 Age: 27 Place of Birth: PATOC, BUCAY, ABRA
School: ASIST - BANGUED CAMPUS Employee Number:
Current Position: INSTRUCTOR I Years in Service: 2 YEARS
Address of School: ZONE 3, BANGUED, ABRA
Present Address: STA. ROSA, BANGUED, ABRA
In Case of Emergency
Please Contact: JOE-ED P. CORPUZ Contact Number: 9394771480
B. Educational Qualifications:
Course (College/Post
School Year Graduated Credits Earned Awards Received
Graduate)
MAFiL ASIST- BANGUED
C. Sports Training Attended for the last three (3) years
Title of Sports Training Date of Training No. of Hours Conducted by
SPORTS CLINIC OCT. 18-20, 2019 24 DepEd Abra
D. Sports Track Record/Experience
Athletic Meet Attended Inclusive Dates Event Awards Received
Prepared by: Attested by: Verified by:
MARY JOY M. CORPUZ
(Coach /Asst. Coach Signature over Printed Name) (Division Sports Officer Signature over Printed Name) (Division AO/SDS Signature over Printed Name)
Screened by:
Division Meet Regional Meet Palarong Pambansa
(Signature of DSAC over Printed Name) (Signature of RSAC over Printed Name) (Signature of NSAC over Printed Name)
Date: ______________ Date: ______________ Date: ______________
FOR SCHOOL SPORTS (Division, Region, Palarong Pambansa)