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B. Application Form_Start-Up

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18 views2 pages

B. Application Form_Start-Up

Uploaded by

payawan farms
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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YOUNG FARMERS CHALLENGE-START-UP 2x2 PICTURE

APPLICATION FORM Photo taken within 6 months

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Part I. Personal Information

___________________________________ ___________________________________
Surname First Name

______________________________________ ____________________ Male


Sex: Female
Middle Name Extension Name

Permanent Address:
________________________ ___________________________ _______________________
House/Lot/Bldg. No/Purok Street/Sitio/Subdv. Barangay
________________________ ___________________________ _______________________
Municipality/City Province Region

Mobile Number: ________________________ Facebook Link (URL): _____________________________


Email Address: _______________________
Are you currently enrolled? Yes No
What academic year are you in:
_____________________________
Highest Formal Education:

Date of Birth: _____/______/______ Pre-School Junior HS Vocational


M D Y Elementary Senior HS Post-Graduate
High School (non-k12) College Others, specify:
Place of Birth: _________________________
______________________________________ ______________

If you are currently enrolled in college or have recently graduated,


please specify your
course:___________________________________________

Religion: _____________________________ Person with Disability (PWD)? Yes No


Name of Spouse Member of an Indigenous Group?
If Married: ___________________________ If yes, specify: ________________ Yes No
Mother’s
Maiden Name: ______________________ With Government Issued ID? Yes No
If yes, specify ID Type:____________
ID No.: _____________
Person to Notify in case of
emergency: __________________ Member of any Farmers Association/ Yes
Contact No: __________________ Cooperative/Organization? No
If yes, specify: __________________

Currently Employed? Yes No


If yes, Name of Employer ______________________
Address: ______________________________
Office Contact No: ______________________
Type of Employment:

Regular Job Order / Contract of Service Casual


Coterminous Others, specify: ___________________________

Official Designation / Position: __________________________________

Have a family relative working in the Department of Agriculture, its bureaus, or attached agencies and Provincial, Municipal, and
City Agricultural Offices within the 4th civil degree of consanguinity or affinity?

Yes No
Have you ever been diagnosed with mental health issue?

Yes No

If yes, please answer the following questions:


1. What are the details?
________________________________________________________________________________________
________________________________________________________________________________________
2. Will it hinder you from performing task and activities related to your project and
compliance to the YFC requirements? Yes No

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Part II. Proposed Enterprise Information
Young Farmers Challenge Entry:
Individual Group

Enterprise Category: Production M Processing (Non-Food)


Processing (Food) M Digital Agriculture

If group managed enterprise, state the names and address of the members:

Name: _______________________ Name: _______________________


Address: _____________________ Address: _____________________

Name: _______________________ Name: _______________________


Address: _____________________ Address: _____________________

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*I hereby declare that all information indicated above are true and correct, and that they may be used by Department of
Agriculture for the purpose of my application for the YFC Start-Up program.

_____________________________
Signature over printed name
YFC START-UP APPLICANT

Date: _______________________

Data Privacy Statement


By filling-out this form you agree with the Data Privacy of the Department of Agriculture and the National Privacy Commission.
Both personal and non-personal information may be collected using this form. Rest assured that data shall be kept safe and
secure, and will not be shared with anyone except for designated personnel who will process the needed information only for
facilitating this competition.

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