*ALL FIELDS SHOULD BE COMPLETED.

THEME: Environmental Issues

Civic Engagement

Social Entrepreneurship and Economic Development

(Check appropriate box)

FIRST NAME
Jan Carlo MIDDLE NAME LAST NAME

Pascual Nicolas

Date of Birth City and Country

(Month/Day/Year) December 28, of Birth Norzagaray,

1997 Philippines

Country of Citizenship Philippines Country of Philippines

Residence

Medical, Physical, Dietary

Restrictions (Please state if you
have any existing medical
conditions or are currently taking
any prescription medication. This
will not affect your selection, but
will enable the host institution to
make any necessary NONE
accommodations. )

Complete Home Address Back of Municipal Compound, Poblacion, Norzagaray,

Bulacan

E-mail Address jancarlonicolas@gmail.com

Tel. and Cellphone No. +63 936 692 0721

Emergency Contact Full

Name and Relationship
Lana Pascual Nicolas - Mother

Emergency Contact
Cellphone No. and Email
Address +63 935 1387 660 nicolas.lana@yahoo.com

School Name and Address Polytechnic University of the Philippines Sta. Mesa,
Manila

Current Year and Major

(If graduated, please indicate year 2nd Year Bachelor of Science Major in Hospitality
and major) Management

Job Position and

Company/Institution (If
currently working) NONE

Evidence of English Fluency

(Indicate if medium of instruction Writer for student publications.

in school is English, list English
fluency test results, list of
publications written, awards from
The Footprint - Norzagaray Elementary School
school related to English
language) The Starlight- Norzagaray National High School

Best Debater Norzagaray National High School

Volunteer Work and

Community Services (Format:
Title of Event/Host Institution or YeaBulacan Gawad Kalinga Community Development
Program Organizer/Type of Role or
Responsibility/Dates of
Foundation/Volunteer/ June 2013 - 2015
Participation)

Memberships in
associations, clubs, etc.
(Format: Club or Association United Nations SDSN Youth Philippines, National
Name, Type of Role or
Responsibility/Dates of
Volunteer/ September 11, 2016
Membership)

Previous Experience in the

U.S. (Reason for travel, city/state
destination and dates of travel) NONE

Family residing in the U.S.

(include FULL name, relation, city NONE
and state)

ADDITIONAL REQUIREMENTS:
CLEAR SCANNED IMAGE of Passport.

PERSONAL STATEMENT:
What about your background and/or interests will make you competitive for this program? How
will your unique strengths contribute to the program? How do you expect this experience to
impact your future academic and professional career? Please be as specific as possible. NOTE:
Please structure your essay in paragraphs and limit your response to 250 words or
approximately half a page, single-spaced.

I have spent most of my life in the province and perhaps one important experience that
has had a huge influence on me the past few years has been college. Moving to the city
to pursue my academic aspirations broadened my view of the world. I was exposed to
different people from myself. The city is full of diversity and I have met people of all
backgrounds and abilities, and I have been fortunate enough to be friends with quite a
few of them. This experience has made me more tolerant of differences. Furthermore, I
have gained a better appreciation and excitement for meeting new people and learning
from them. With this, I believe that this program could cater directly to my needs.

My past experiences in volunteering have occupied a large portion of my time in college.

Along with this experience have come knowledge and skills that could never be gained in
the classroom. I have become very passionate about learning more and more about the
global issues and how it directly affects me and what solutions I could produce as a
young individual. Im a hard worker with, drive, willingness to learn, honesty, integrity,
and pride. I sing, too.

In my undergraduate studies, it is essential to gain experience meeting people from all

walks of life. This helps to develop our communication and socializing skills which is very
important in the hospitality industry. This would also be a valuable opportunity for me to
learn from highly experienced people from community building, political leadership, and
volunteerism because I want to work in the development sector.