UniFAST TDP Form Annex 1

2022 version
(NOT FOR SALE)

2x2
CHED Regional Office NCR 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 Ite m is not applicable, indicate "NA".

PERSONAL INFORMATION
PAZ RHEY ANN REFORMA NA
Name Maiden Name
(Last Name) (First Name) (Middle Name)
(for Married Women)
Date of Birth
11/11/2002 Permanent Address Zip Code
(mm/dd/yyyy)
161 POSADAS AVE.
BRGY. SUCAT
MUNTINLUPA CITY NA
Street & Town/City/ 1770
Place of Birth Bacoor City Province
Barangay Municipality
Name of School Attended COLEGIO DE MUNTINLUPA

___ Male School ID Number 13454

Sex
 Female School Address POSADAS AVE., SUCAT, MUNTINLUPA CITY
Citizenship FILIPINO School Sector () Public ( ) Private
Tribal Membership
Mobile Number 09319033588 Year Level 3RD YEAR Course
(if applicable)
Type of Disability BACHECLOR OF SCIENCE
E-mail Address [email protected] NA
RHEUMATIC HEART DISEASE IN CIVIL ENGINEERING
FAMILY BACKGROUND
Father: (  ) Living ( ) Deceased Mother: ( ) Living ( ) Deceased
Name ARCEO PAZ JR. ERLINDA R. PAZ
Address BACOOR CITY CAVITE BACOOR CITY CAVITE
Occupation CONSTRUCTION HOUSEWIFE
Total Parents Gross income 30,000 No. of Siblings in the family 4
Are you enjoying other educational financial assistance?  Yes or ___No
If yes, please specify 1. _____________________________
2. _____________________________

QUALIFICATION REQUIREMENTS
per Section 1 of the Memorandum Circular No. __ s. 2022.
TERMS AND CONDITIONS
Data Privacy
An applicant for this grant must be a Filipino citizen with a combined household
(parents/guardian) gross income which shall not exceed Four Hundred Thousand Pesos
a. In connection with my application for the Tertiary Education Subsidy (TES) Program/ Tulong-Dunong
(PhP400,000.00) and maybe classified as one of the following:
Program (TDP), I authorize partner Higher Education Institutions (HEIs), the Commission on Higher
Education (CHED), and the Unified Student Financial Assistance System for Tertiary Education
5.1 New TDP-TES Grantee must be enrolled in any first undergraduate degree in
(UniFAST) Secretariat, its representatives, and outsourced service providers, if any, to collect, process
SUCs, CHED-Recognized LUCs and Private HEIs that are in the CHED Registry of
update or disclose personal information about me/us in accordance with the Data Privacy Act of 2012,
Programs and Institutions.
its Implementing Rules and Regulations (IRR), and to verify, my personal information from any person or
entity that may deem necessary under applicable laws, rules, and regulations.
DOCUMENTARY REQUIREMENTS per Section 3 of the Memorandum Circular No. __
b. I agree to hold partner HEIs, CHED, and UniFAST and the persons or entities from whom it m ay obtain,
s. 2022.
or with whom it may disclose or verify my personal information free and harmless from any liability arising
6.2.1 a. For new applicants:
from the use of any information.
Participating higher education institutions (HEIs) must submit, to the respective CHED
c. I confirm that I am aware that under the Data Privacy Act, I have (a) the right to withdraw the consent
Regional Offices, a certified true copy or electronically-generated copy of the list of enrolled
hereby given or to object to the processing of my personal information provided there is no other legal
student- applicants with total number of units enrolled (Annex 5), with the attached certified
ground or overriding legitimate interest to the processing thereof; (b) right to reasonable fees, (c) right to
electronically generated Certificate of Registration/Enrolment (CORs/COEs) as proof of
rectification, and (d) right to erasure or blocking of my personal information subject, however, to the
enrollment.
conditions for the legitimate exercise of the said rights under the Data Privacy Act and its IRR, and subject
further to the right of partner HEIs, CHED, and UniFAST to terminate the program availed by me should
6.2.2 (Income Requirement) New applicants and continuing grantees shall submit a
I withdraw my consent or request the removal of my personal information.
Certificate of Indigency as proof of income, duly issued by the Punong Barangay where the
applicant resides.
I hereby certify that foregoing statements are true and correct.

RHEY ANN R. PAZ ______________________________

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)

Documents Attached
Certificate of Registration/Enrolment (CORs/COEs) _________
Certificate of Indigency _________
Evaluated /Processed by:

______________________________
UniFAST Regional Coordinator