RIZAL TECHNOLOGICAL UNIVERSITY

Cities of Mandaluyong and Pasig

❑CAS ❑CBET ❑CEAT ❑CED ❑IPE

School Year: Date

Semester: Course: Year Level:

Name of
Student:

Surname Given Name M.I.

STATEMENT OF RESPONSIBILITY, RELEASE OF LIABILITY,

AND AGREEMENT FOR AVAILING OF TERTIARY EDUCATION SUBSIDY (TES), EXPANDED
STUDENTS’ GRANTS-IN-AID PROGRAM FOR POVERTY ALLEVIATION (ESGP-PA) and TULONG
DUNONG PROGRAM (TDP)

A Student is ELIGIBLE to avail the Tertiary Education Subsidy (TES), Expanded Students’
Grants-In-Aid Program for Poverty Alleviation (ESGP-PA) and Tulong Dunong Program (TDP)
provided by the UniFAST if he/she conforms under the following conditions:

□ Have not received a grade of 5.00 in three (3) subjects during the regular / summer term
or have not been placed repeatedly under Academic Warning or Academic Probation for
their course or program curriculum.

□ Have not been on official “Leave of Absence” for more than one (1) academic year for the
entire semesters for their course or program curriculum.

□ Not an overstaying student and still meet the maximum residency rule of the university as
provided by law.

I hereby understand, agree, and acknowledge that upon failing to meet the above-cited minimum
requirements, the University assumes no responsibility or liability, in whole or in part, for my
disqualification to TES, ESGP-PA and TDP

Student’s Signature / Date

Witness:

(Signature over Printed Name / Date)

PARENT OR GUARDIAN

(Signature over Printed Name / Date) (Signature over Printed Name / Date)
DEAPARTMENT HEAD DEAN
 RIZAL TECHNOLOGICAL UNIVERSITY
Cities of Mandaluyong and Pasig

❑CAS ❑CBET ❑CEAT ❑CED ❑IPE

School Year: Date

Semester: Course: Year Level:

Name of
Student:

Surname Given Name M.I.

STATEMENT OF RESPONSIBILITY, RELEASE OF LIABILITY,

AND AGREEMENT FOR AVAILING OF FREE HIGHER EDUCATION PROGRAM OF RA10931

A Student is ELIGIBLE to avail the Free Higher Education (FHE) Program which covers free
tuition and miscellaneous fees provided by the UniFAST if he/she conforms under the following
conditions:

□ Maintain “Good Academic Standing” and should meet the Retention Policy of the university
based on the BOR Resolution No. 813 Series of 2018.

□ Have not been on official “Leave of Absence” for more than one (1) academic year for the
entire semesters for their course or program curriculum.

□ Have not received a grade of 5.00 in three (3) subjects during the regular / summer term or
have not been placed repeatedly under Academic Warning or Academic Probation for their
course or program curriculum.

□ Not an overstaying student and still meet the maximum residency rule of the university as
provided by law.

I hereby understand, agree, and acknowledge that upon failing to meet the above-cited minimum
requirements, the University assumes no responsibility or liability, in whole or in part, for my
disqualification to FHE.

Student’s Signature / Date

Witness:

(Signature over Printed Name / Date)

PARENT OR GUARDIAN

(Signature over Printed Name / Date) (Signature over Printed Name / Date)
DEAPARTMENT HEAD DEAN