Ateneo de Manila University School of Medicine and Public Health Admissions Office ADMISSIONS INTERVIEW PERSONAL DATA PROCESSING CONSENT FORM In confirming my slot for the admissions interview of the Ateneo De Manila University School of ‘Medicine and Public Health (ASMPH) I acknowledge that I have read and understood its applicable Privacy Policy. I also agree to be bound by and/or to comply with the following; Republic Act No. 10173, or the Data Privacy Act of 2012 (DPA), and other relevant data protection laws apply to the collection and processing of my personal data. Lam allowing ASMPH to collect, use, and process the personal data I provide during the admissions interview process in accordance with the relevant provisions of the DPA, other applicable data protection laws, and the University’s relevant Privacy Policy. understand thata third-party platform may be used to conduct the interview and is covered by the company’s own privacy policy. My admissions interview will be recorded for relevant purposes such as deliberations relating to my application, and documentation. Video recordings will be stored and kept secure within three (3) years. After this period, they will be deleted from the ASMPH's database. Moreover, I also confirm my consent to the following (NOTE: Indicate your preference by marking the appropriate box): AMPH may use the video recording of my admissions interview to conduct a research study. Access to the same will be limited only to authorized ASMPH personnel. Nether sy name nor any other identifying information (auch as my voice or picture) will be used in presentations or in written products resulting from the study. T understand that all access to my personal data shall be governed by appropriate access restriction policies and other University policies that-sim to ensure the confidentiality and/or security of such data. likewise understand that I have rights under the DPA relative to my personal data which I ‘may invoke in accordance with the provisions of the law. [agree to keep all matters relating to the admissions interview with the strictest confidentiality. Under no circumstances shall | intentionally, or unintentionally, or imprudently divulge information about the interviews to any party outside my immediate family. Should you have any concem or question regarding this Consent form, you may contact the Ateneo ‘School of Medicine and Public Health Office of the Associate Dean at: Telephone No. = _+637063086 loc 3010, Email Address assoclatedean.asmphatenco.eds ‘Ateneo School of Medicine and Public Health ‘Don Eugenio Lopez, Sr. Medical Complex Ortigas Avenue, Pasig City