Annex 2 TDP Application Form.docx

PERSONAL INFORMATION
Name
	(Last Name)	(First Name)			(Middle Name)			Maiden Name (for Married Women)
Date of Birth (mm/dd/yyyy)		Permanent Address						Zip Code
Place of Birth
		Street & Barangay		Town/City/ Municipality		Province
		Name of School Attended
Sex	___ Male ___ Female	Campus
		Course
Citizenship		Year Level
Mobile Number		School ID Number
		School Address
E-mail Address		School Sector			( ) Public ( ) Private
		Type of Disability (if applicable)
FAMILY BACKGROUND
		Father: () Living () Deceased					Mother: ( ) Living ( ) Deceased
Name
Address
Are you enjoying other educational financial assistance? __Yes or ___No If yes, please specify 1. _____________________________
QUALIFICATION REQUIREMENTS per Section 1 of the Memorandum Circular No. __ s. 2024. New TDP applicants must be enrolled in any first undergraduate degree in SUCs, CHED-Recognized LUCs or Private HEIs that are in the CHED Registry of Programs and Institutions not availing multiple national government-funded assistance, except for Free Higher Education in SUCs and LUCs under R.A. 10931 or the Universal Access to Quality Tertiary Education Act, and DSWD Assistance to Individuals in Crisis Situation (AICS) DOCUMENTARY REQUIREMENTS per Section 3 of the Memorandum Circular No. __ s. 2024. NEW TDP applicants shall submit the TDP Application form together with the Certified True Copy or electronically-generated copy of the Certificate of Enrollment (COE) or Certificate of Registration (COR) and original copy of Certificate of Indigency issued by the Punong Barangay where the applicant resides. In cases only when the Certificate of Indigency cannot be secured, Certificate of Tax Exemption or Social Case Study issued by a registered Social Worker may be submitted.			PRIVACY NOTICE In connection with my application for the Tertiary Education Subsidy (TES) Program/ Tulong-Dunong 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 (UniFAST) Secretariat, its representatives, and outsourced service providers, if any, to collect, process update or disclose personal information about me/us in accordance with the Data Privacy Act of 2012, 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. CONSENT I agree to hold partner HEIs, CHED, and UniFAST and the persons or entities from whom it may obtain, or with whom it may disclose or verify my personal information free and harmless from any liability arising from the use of any information. I confirm that I am aware that under the Data Privacy Act, I have (a) the right to withdraw the consent hereby given or to object to the processing of my personal information provided there is no other legal ground or overriding legitimate interest to the processing thereof; (b) right to reasonable fees, (c) right to rectification, and (d) right to erasure or blocking of my personal information subject, however, to the 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 I withdraw my consent or request the removal of my personal information.
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