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 Item is not applicable, indicate "NA".

PERSONAL INFORMATION

Name Maiden Name

(Last Name) (First Name) (Middle Name)
(for Married Women)
Date of Birth
Permanent Address Zip Code
(mm/dd/yyyy)

Town/City/
Place of Birth Street & Barangay Province
Municipality
Name of School Attended COLEGIO DE MUNTINLUPA

___ Male School ID Number 13454

Sex
___ Female School Address POSADAS AVE., SUCAT, MUNTINLUPA CITY
Citizenship School Sector () Public ( ) Private
Tribal Membership
Mobile Number Year Level Course
(if applicable)
Type of Disability
E-mail Address
(if applicable)
FAMILY BACKGROUND
Father: ( ) Living ( ) Deceased Mother: ( ) Living ( ) Deceased
Name
Address
Occupation
Total Parents Gross income No. of Siblings in the family
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 may obtain,
s. 2022.
or with whom it may disclose or verify my personal information free and harmless from any liability
6.2.1 a. For new applicants:
arising 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
electronically generated Certificate of Registration/Enrolment (CORs/COEs) as proof of
to 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
6.2.2 (Income Requirement) New applicants and continuing grantees shall submit a
me should 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.

___________________________________ ______________________________
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