UniFAST TDP Form Annex 1

2022 version
(NOT FOR SALE)

CHED Regional Office ___

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)

Place of Birth Street & Barangay Town/City/ Province

Municipality
Name of School Attended

___ Male School ID Number

Sex
___ Female School Address
Citizenship School Sector ( ) Public ( ) Private

Mobile Number Year Level Course Tribal Membership

(if applicable)
E-mail Address Type of Disability
(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 TERMS AND CONDITIONS
per Section 1 of the Memorandum Circular No. __ s. 2022. Data Privacy

An applicant for this grant must be a Filipino citizen with a combined

a. In connection with my application for the Tertiary Education Subsidy (TES) Program/ Tulong-Dunong Program (TDP), I
household (parents/guardian) gross income which shall not exceed
Four Hundred Thousand Pesos (PhP400,000.00) and maybe authorize partner Higher Education Institutions (HEIs), the Commission on Higher Education (CHED), and the Unified
classified as one of the following: 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
5.1 New TDP-TES Grantee must be enrolled in any first Data Privacy Act of 2012, its Implementing Rules and Regulations (IRR), and to verify, my personal information from any
undergraduate degree in person or entity that may deem necessary under applicable laws, rules, and regulations.
SUCs, CHED-Recognized LUCs and Private HEIs that are in the b. I agree to hold partner HEIs, CHED, and UniFAST and the persons or entities from whom it may obtain, or with whom it
CHED Registry of Programs and Institutions.
may disclose or verify my personal information free and harmless from any liability arising from the use of any
DOCUMENTARY REQUIREMENTS per Section 3 of the information.
Memorandum Circular No. __ s. 2022. c. 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
6.2.1 a. For new applicants: object to the processing of my personal information provided there is no other legal ground or overriding legitimate
Participating higher education institutions (HEIs) must submit, to the interest to the processing thereof; (b) right to reasonable fees, (c) right to rectification, and (d) right to erasure or blocking
respective CHED Regional Offices, a certified true copy or of my personal information subject, however, to the conditions for the legitimate exercise of the said rights under the Data
electronically-generated copy of the list of enrolled student- Privacy Act and its IRR, and subject further to the right of partner HEIs, CHED, and UniFAST to terminate the program
applicants with total number of units enrolled (Annex 5), with the
availed by me should I withdraw my consent or request the removal of my personal information.
attached certified electronically generated Certificate of
Registration/Enrolment (CORs/COEs) as proof of enrollment.

6.2.2 (Income Requirement) New applicants and continuing

grantees shall submit a 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