Annex 2 Privacy Notice and Consent Form

Senior High School Voucher Program Application

Parent Consent Form

This is a REQUIRED document for applicants who are below 18 years old at the
time of the submission of the application.

I grant my consent for my child (student-applicant) to provide the necessary

information and documents needed to complete the Senior High School Voucher
Program application process.

_____VIRGINIA C. AUTIDA__________________
Signature over printed name of the parent/guardian

Date signed:__July 9, 2020___________________________________

Additional information on the student-applicant:

1. Full name: _____LUIGI

CISNERO____________________________________

2. Age: _16_____ 3. Birthdate (mm/dd/yyyy) ____04/23/2004_____

4. Address: ____Brgy. Oraan East Manaoag, Pangasinan_

5. JuniorHighSchool:Cabanbanan National High

School___________________________________________

6. Contact number of the parent/guardian:

__09129283420________________________