UniFAST TDP Form ANNEX "A"

2020 version (NOT FOR SALE)

Republic of the Philippines
Unified Student Financial Assistance System for Tertiary Education 2x2
REGIONAL OFFICE ____
ID PICTURE

UniFAST TULONG DUNONG PROGRAM (UniFAST-TDP)

APPLICATION FORM
Instructions. Read General and Documentary Requirements. Fill in all the required information. Do not leave an item blank Item is not applicable, indicate "NA".

PERSONAL INFORMATION

Name (Last Name) (First Name) (Middle Name) Maiden Name

put extension if any ie. Jr., III (for Married Women)

Date of Birth
Permanent Address Zip Code
(mm/dd/yyyy)

Place of Birth

Street & Barangay Town/City/ Province

Municipality

Sex Male Female Name of School Last Attended

Single Widowed School ID Number

Civil Status Married Separate
v School Address
Others
Citizenship School Sector ( ) Public ( ) Private

Mobile Number Highest Attained Grade Year Level Tribal Membership

(if applicable)
E-mail Address Type of Disability
(if applicable)
FAMILY BACKGROUND
Father: () Living () Deceased Mother: () Living () Deceased

Name

Address

Occupation

Educational Attainment

Total Parents Gross Income No. of Siblings in the family

School Intended to enroll or enrolled in: _____________________________________________________________________________ ________

School Address:_____________________________________________________________________________________________________________
Type of School: ( ) Public ( ) Private
Degree Program:____________________________________________________________________________________________________________
Type Grantee Institution/Agency
Are you enjoying other educational financial assistance? __Yes or ___No If yes, please specify 1.______ _____________________________
2. ______ _____________________________
I hereby certify that foregoing statements are true and correct.
___________________________________ ______________________________
Signature over Printed Name of Applicant Date Accomplished
Note: Fully accomplished form to be submitted to the CHEDRO

DO NOT FILL-OUT THIS PORTION FOR CHEDRO USE ONLY)

Belong to (any of the following groups): Documents Attached
( ) dependent of solo parent Report Card _________
( ) senior citizens COR _________
( ) persons with disabilities. please specify type of disability _________ Certified True Copy Of Grades _________
( ) Indigenous and ethnic peoples. please specify membership _________ Latest ITR _________
Total _________

Evaluated Processed by:

______________________________
UniFAST Regional Coordinator
QUALIFICATION REQUIREMENTS per Section 5 of the UniFAST Memorandum Circular DOCUMENTARY REQUIREMENTS per Section 6 of the UniFAST Memorandum Circular No. 02 s. 2021.
No. 02 s. 2021. 6.2.1 ACADEMIC REQUIREMENTS
a. Qualified Incoming Freshmen students- Certified True Copy of Senior High School Report Card and
Certificate of Registration (COR) of school currently enrolled.
An applicant for this grant must be a Filipino citizen with a combined household b. For applicants with Earned Units in College in CHED recognized programs of Private HEls, LUCs and SUCS
(parents/guardian) gross income which shall not exceed Four Hundred Thousand Pesos with COPC - duly certified true copy of grades for the latest term/semester attended and COR of school
(PhP400,000.00) and maybe classified as one of the following: currently enrolled.
c. For Other Applicants
c.1 ALS Passer - duly certified copy of ALS Accreditation and Equivalency TEST Passer Certificate and COR of
5.1 An Ongoing Grantee must be TDP-TES grantee in A.Y. 2019-2020 and is currently school currently enrolled; and
enrolled in the First Semester of Academic Year 2020-2021, in any recognized curricular c.2 Philippine Educational Placement Test (PEPT) Passer - duly certified copy of PEPT Certificate advancing
program year level in both Public and Private HEls, ongoing TDP-TES grantees shall to the next level and COR of school currently enrolled
submit an accomplished TDP-TES Application Form for updating purposes; and 6.2.2 Income Requirement
5.2 New TDP-TES Grantees in AY 2020-2021 and the succeeding academic years must be The student-applicant shall submit any one of the following:
a Senior High School graduate; or an ongoing college student with earned units in CHED- a: Latest copy of contract or proof of income, for the children of Overseas Filipino Workers and seafarers;
recognized programs of Private HEls, SUCs or LUCs with Certificate of Program b. Case Study prepared and issued by the Municipal Social Welfare and Development Officer who must be a
Compliance (COPC) with at least a passing general weighted average (GWA); or a passer licensed social worker;
of the Alternative Learning Systems (ALS)/ Philippine Educational Placement TEST c. Latest Income Tax Return and Bureau of Internal Revenue Form 2316 for
(PEPT). fixed Income earners of parents/guardians, if employed; or
d. Certificate of Tax Exemption from the BIR of parents/guardian, if not employed.

NOTE: APPLICANT MUST NOT HAVE ANY AVAILMENT OF OTHER GOVERNMENT

FUNDED ASSISTANCE EXCEPT FREE TUITION FEE IF ENROLLED TO SUCS AND LUCs.