TDP-SUC Form Annex 1

(NOT FOR SALE)

TULONG DUNONG PROGRAM(TDP-SUC)

APPLICATION FORM 2x2
ID PICTURE
Instruction: Read the General and Documentary Requirements carefully. Fill out all required information completely. If an item is not applicable, indicate “NA.”
Do not leave any field blank.

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 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: _____________________________
QUALIFICATION REQUIREMENTS TERMS AND CONDITIONS
per Section 4 of the Memorandum Circular No. __ s. 2023 Data Privacy

An applicant for this grant must be a Filipino citizen, provided, that

a. In connection with my application for the Tulong-Dunong Program for SUC (TDP-SUC), I authorize partner State Universities
the applicant is enrolled in any first undergraduate degree included
in the CHED Registry of Programs and Institutions, provided, further, and Colleges (SUCs) and its representatives, and outsourced service providers, if any, to collect, process update or disclose
that the applicant has not been a recipient of TDP grant, Tertiary personal information about me/us in accordance with the Data Privacy Act of 2012, its Implementing Rules and Regulations
Education Subsidy (TES), or any nationally-funded government (IRR), and to verify, my personal information from any person or entity that may deem necessary under applicable laws, rules,
Student Financial Assistance Program (STuFAP), except Free and regulations.
Higher Education (FHE), in previous academic years. b. I agree to hold partner SUCs 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.
DOCUMENTARY REQUIREMENTS per Section 6 of the
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 object
Memorandum Circular No. __ s. 2023.
to the processing of my personal information provided there is no other legal ground or overriding legitimate interest to the
6.1. (Academic Requirement) processing thereof; (b) right to reasonable fees, (c) right to rectification, and (d) right to erasure or blocking of my personal
TDP-SUCs applicants shall submit to the Scholarship Office the information subject, however, to the conditions for the legitimate exercise of the said rights under the Data Privacy Act and its
Certificate of Registration/Enrolment (COR/COE) for the First IRR, and subject further to the right of partner SUCs to terminate the program availed by me should I withdraw my consent or
Semester of AY 2023-2024 as proof of enrollment. request the removal of my personal information.

6.2 (Income Requirement)

TDP-SUCs applicants 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 SUC authorized personnel

DO NOT FILL-OUT THIS PORTION FOR SUC AUTHORIZED PERSONNEL USE ONLY)

Documents Attached
Certificate of Registration/Enrolment (CORs/COEs) _____ Certificate of Indigency (of parents) _____
Certificate of Grades of previous sem (for higher years) ____ Grade 12 Report Card for incoming 1st year _________
Evaluated /Processed by:
______________________________
SUC Authorized Personnel