UniFAST TDP Form Annex 2

2024 version
(NOT FOR SALE)

2x2
CHED 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

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

Street & Town/City/ Province

Place of Birth
Barangay Municipality
Name of School Attended

___ Male Campus

Sex
___ Female Course

Citizenship Year Level

School ID Number
Mobile Number
School Address
School Sector ( ) Public ( ) Private
E-mail Address
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 PRIVACY NOTICE
per Section 1 of the Memorandum Circular No. __ s. 2024. ● 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),
New TDP applicants must be enrolled in any first undergraduate degree in SUCs,
and the Unified Student Financial Assistance System for Tertiary Education (UniFAST) Secretariat, its
CHED-Recognized LUCs or Private HEIs that are in the CHED Registry of
Programs and Institutions not availing multiple national government-funded representatives, and outsourced service providers, if any, to collect, process update or disclose personal
assistance, except for Free Higher Education in SUCs and LUCs under R.A. information about me/us in accordance with the Data Privacy Act of 2012, its Implementing Rules and
10931 or the Universal Access to Quality Tertiary Education Act, and DSWD Regulations (IRR), and to verify, my personal information from any person or entity that may deem necessary
Assistance to Individuals in Crisis Situation (AICS) 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
DOCUMENTARY REQUIREMENTS per Section 3 of the Memorandum
Circular No. __ s. 2024. with whom it may disclose or verify my personal information free and harmless from any liability arising from
the use of any information.
NEW TDP applicants shall submit the TDP Application form together with the ● I confirm that I am aware that under the Data Privacy Act, I have (a) the right to withdraw the consent hereby
Certified True Copy or electronically-generated copy of the Certificate of given or to object to the processing of my personal information provided there is no other legal ground or
Enrollment (COE) or Certificate of Registration (COR) and original copy of overriding legitimate interest to the processing thereof; (b) right to reasonable fees, (c) right to rectification,
Certificate of Indigency issued by the Punong Barangay where the applicant
and (d) right to erasure or blocking of my personal information subject, however, to the conditions for the
resides. In cases only when the Certificate of Indigency cannot be secured,
legitimate exercise of the said rights under the Data Privacy Act and its IRR, and subject further to the right
Certificate of Tax Exemption or Social Case Study issued by a registered Social
Worker may be submitted. 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