UniFAST TDP Form ANNEX "A"

2020 version (NOT FOR SALE)

Republic of the Philippines
Unified Student Financial Assistance System for Tertiary Education
REGIONAL OFFICE ____ 2x2
UniFAST TULONG DUNONG PROGRAM (UniFAST-TDP) ID PICTURE
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/Municipalit Province

y

Sex Male Female Name of School Last Attended

Single Widowed School ID Number

Civil Status Married Separate
v School Address

Citizenship School Sector ( ) Public ( ) Private

Mobile Number Highest Attained Grade Year Level Tribal Membership

(if applicable)
E-mail Address Type of Disability
(if applicable)
FAMILY BACKGROUND
Father: ( ) Living ( ) Deceased Mother: ( ) Living ( ) Deceased
Name
Address
Occupation
Educational Attainment
Total Parents Gross Income No. of Siblings in the family: _____
School Intended to enroll or enrolled in: _____________________________________________________________________________________
School Address:_____________________________________________________________________________________________________________
Type of School: ( ) Public ( ) Private
Degree Program:____________________________________________________________________________________________________________
Type Grantee Institution/Agency
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.
___________________________________ ______________________________
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 Circular No. __ s. 2020. DOCUMENTARY REQUIREMENTS per Section 6 of the Joint Circular No. __ s. 2020.
1. Filipino Citizen ACADEMIC REQUIREMENTS
2. Combines annual gross Income of parents/guardian not to exceed Four Hundred Thousand Pesos a. Qualified Incoming Freshmen students- Certified True Copy of Senior High School Report Card and COR of school currently enrolled.
(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 and SUCS with COPC - duly certified
a. An Ongoing Grantee must be TDP-TES beneficiary in A.Y. 2019-2020 and is currently true copy of grades for the latest term/semester attended and COR of school currently enrolled.
enrolled in the First Semester of Academic Year 2020-2021, in any recognized curricular program year level in c. For Other Applicants
both Public and Private HEls; and c.1 ALS Passer - duly certified copy of ALS Accreditation and Equivalency TEST Passer Certificate and COR of school currently
b. New TDP-TES Grantees in AY 2020-2021 must be a Senior High School graduate; or an ongoing college enrolled.; and .
student with earned units in CHED-recognized programs of Private HEIS, SUCs or LUCs with Certificate of c.2 Philippine Educational Placement Test (PEPT) Passer – duly certified copy of PEPT Certificate advancing to the next level and COR
Program Compliance (COPC) with at least a passing general weighted average (GWA); or a passer of the of school currently enrolled.
Alternative Learning Systems (ALS) Philippine Educational Placement TEST (PEPT).
INCOME REQUIREMENTS
NOTE: APPLICANT MUST NOT HAVE ANY AVAILMENT OF OTHER GOVERNMENT FUNDED ASSISTANCE EXCEPT The student-applicant shall submit any one of the following:
FREE TUITION FEE IF ENROLLED TO SUCS AND LUCs. a. Latest copy of contract or proof of income, for the children of Overseas Filipino Workers and seafarers;
b. Case Study prepared and issued by the Municipal Social Welfare and Development Officer who must be a licensed social worker;
C. Latest Income Tax Return and Bureau of Internal Revenue Form 2316 for fixed income earners of parents/guardians, if employed; or
d. Certificate of Tax Exemption from the BIR of parents/guardian, if not employed