Republic of the Philippines Unified Student Financial Assistance System for Tertiary Education 2x2 REGIONAL OFFICE IV 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
put extension if any ie. Jr., III (for Married Women) Date of Birth Permanent Address Zip Code (mm/dd/yyyy)
Place of Birth
Street & Barangay Town/City/Municipality Province
Sex Male Female Name of School Last Attended
Single Widowed School ID Number
Civil Status Married Separate v School Address Others 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 QUALIFICATION REQUIREMENTS per Section 5 of the UniFAST Memorandum Circular DOCUMENTARY REQUIREMENTS per Section 6 of the UniFAST Memorandum Circular No. 02 s. 2021. No. 02 s. 2021. 6.2.1 ACADEMIC REQUIREMENTS a. Qualified Incoming Freshmen students- Certified True Copy of Senior High School Report Card and An applicant for this grant must be a Filipino citizen with a combined household Certificate of Registration (COR) of school currently enrolled. (parents/guardian) gross income which shall not exceed Four Hundred Thousand Pesos b. For applicants with Earned Units in College in CHED recognized programs of Private HEls, LUCs and SUCS (PhP400,000.00) and maybe classified as one of the following: with COPC - duly certified true copy of grades for the latest term/semester attended and COR of school currently enrolled. 5.1 An Ongoing Grantee must be TDP-TES grantee in A.Y. 2019-2020 and is currently c. For Other Applicants enrolled in the First Semester of Academic Year 2020-2021, in any recognized curricular c.1 ALS Passer - duly certified copy of ALS Accreditation and Equivalency TEST Passer Certificate and COR of program year level in both Public and Private HEls, ongoing TDP-TES grantees shall submit school currently enrolled; and an accomplished TDP-TES Application Form for updating purposes; and c.2 Philippine Educational Placement Test (PEPT) Passer - duly certified copy of PEPT Certificate advancing to 5.2 New TDP-TES Grantees in AY 2020-2021 and the succeeding academic years must be the next level and COR of school currently enrolled a Senior High School graduate; or an ongoing college student with earned units in CHED- 6.2.2 Income Requirement recognized programs of Private HEls, SUCs or LUCs with Certificate of Program The student-applicant shall submit any one of the following: Compliance (COPC) with at least a passing general weighted average (GWA); or a passer a: Latest copy of contract or proof of income, for the children of Overseas Filipino Workers and seafarers; of the Alternative Learning Systems (ALS)/ Philippine Educational Placement TEST (PEPT). b. Case Study prepared and issued by the Municipal Social Welfare and Development Officer who must be a licensed social worker; NOTE: APPLICANT MUST NOT HAVE ANY AVAILMENT OF OTHER GOVERNMENT c. Latest Income Tax Return and Bureau of Internal Revenue Form 2316 for FUNDED ASSISTANCE EXCEPT FREE TUITION FEE IF ENROLLED TO SUCS AND LUCs. fixed Income earners of parents/guardians, if employed; or d. Certificate of Tax Exemption from the BIR of parents/guardian, if not employed.