UniFAST TDP Form ANNEX "A"

2020 version (NOT FOR SALE)

Republic of the Philippines

Unified Student Financial Assistance System for Tertiary Education 2x2
National Capital Region 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

Deloria Mark Darryl Mansay (for Married Women)
Date of Birth 02/25/2000 Permanent Address Zip Code
(mm/dd/yyyy)

Place of Birth Quezon City 16th Avenue & San Quezon City Metro Manila 1109
Roque
Street & Barangay Town/City/Municipality Province
Sex Male Female Name of School Last Attended Rizal Technological University
Single Widowed School ID Number 2018-101482
Civil Status Married Separate
704 Boni Ave Cor Sacrepante, Mandaluyong 1550 , Metro Manila ,
Others
v School Address Philippines

Citizenship Filipino School Sector ✔ Public ( ) Private

Mobile Number 09061540491 Highest Attained Grade Year Level 2nd Year Tribal Membership
(if applicable)
E-mail Address markdarryldeloria25@gmail.com Type of Disability N/A
(if applicable)
FAMILY BACKGROUND

Father: ✔ Living () Deceased Mother: ✔ Living () Deceased

Name Ralph L Deloria Mishel M. Deloria
Address #8-16th Avenue, Murphy Cubao, Quezon City #8-16th Avenue, Murphy Cubao, Quezon City
Occupation Factory Worker Worker in Cityhall
Educational Attainment College Graduate College Graduate
Total Parents Gross income 13,000.00 No. of Siblings in the family 2
School Intended to enroll or enrolled in: Rizal Technological University
School Address: 704 Boni Ave Cor Sacrepante, Mandaluyong 1550 , Metro Manila , Philippines

Type of School: ✔ Public ( ) Private

Degree Program: Bachelor of Science in Civil Engineering

Are you enjoying other educational financial assistance? __Yes or ✔ No If yes, please specify 1. ______ _____________________________
2. ______ _____________________________
I hereby certify that foregoing statements are true and correct.

MARK DARRYL M. DELORIA May 26, 2021

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)
Belong to (any of the following groups): Documents Attached
( ) dependent of solo parent Report Card _________
( ) senior citizens COR _________
( ) persons with disabilities. please specify type of disability _________ Certified True Copy Of Grades _________
( ) Indigenous and ethnic peoples. please specify membership _________ Latest ITR _________
Total _________
Evaluated Processed by:
______________________________
UniFAST Regional Coordinator
GENERAL QUALIFICATION REQUIREMENTS per Section 5 of the Joint DOCUMENTARY REQUIREMENTS per Section 6 of the Joint Circular No. __ s. 2020.
Circular No. __ s. 2020. ACADEMIC REQUIREMENTS
1. Filipino Citizen a. Qualified Incoming Freshmen students- Certified True Copy of Senior High School Report Card and
2. Combines annual gross Income of parents/guardian not to exceed Four Hundred COR of school currently enrolled.
Thousand Pesos (PhP400,000.00) and maybe classified as one of the following: b. For applicants with Earned Units in College in CHED recognized programs of Private HEIS, LUCs
a. An Ongoing Grantee must be TDP-TES beneficiary in A.Y. 2019-2020 and and SUCS with COPC - duly certified true copy of grades for the latest term/semester attended and COR
is currently of school currently enrolled.
enrolled in the First Semester of Academic Year 2020-2021, in any recognized c. For Other Applicants
curricular program year level in both Public and Private HEls; and c.1 ALS Passer - duly certified copy of ALS Accreditation and Equivalency TEST Passer Certificate
b. New TDP-TES Grantees in AY 2020-2021 must be a Senior High School and COR of school currently enrolled.; and .
graduate; or an ongoing college student with earned units in CHED-recognized c.2 Philippine Educational Placement Test (PEPT) Passer – duly certified copy of PEPT Certificate
programs of Private HEIS, SUCs or LUCs with Certificate of Program advancing to the next level and COR of school currently enrolled.
Compliance (COPC) with at least a passing general weighted average (GWA);
or a passer of the Alternative Learning Systems (ALS) Philippine Educational INCOME REQUIREMENTS
Placement TEST (PEPT). The student-applicant shall submit any one of the following:
a. Latest copy of contract, for the children of Overseas Filipino Workers and seafarers;
NOTE: APPLICANT MUST NOT HAVE ANY AVAILMENT OF OTHER b. Case Study prepared and issued by the Municipal Social Welfare and Development Officer who must be
GOVERNMENT FUNDED ASSISTANCE EXCEPT FREE TUITION FEE a licensed social worker, if not employed;
IF ENROLLED TO SUCS AND LUCs. C. Latest Income Tax Return and Bureau of Internal Revenue Form 2316 for fixed income earners of
parents/guardians, if employed;
d. Certificate of Tax Exemption from the BIR of parents/guardian.