QUEZON CITY YOUTH ORGANIZATION REGISTRATION FORM

The Quezon City Youth Organization Registration is provided by the Quezon City Youth Development Office in assistance to the National Youth Commission's Youth
Organization Registration Program in gathering necessary documentary requirements for the registration of Youth and Youth Serving Organizations as stated on the
Revitalized Guideline of YORP 2017, and as mandated by Ordinance No. SP-2803, series of 2018.

TYPE OF REGISTRATION New Registration Renewal

ORGANIZATION PROFILE
Name of Organization

Organization’s Address

Building No Street Barangay District Municipality/City

Major Classification Sub-Classification Primary Advocacy

Education
Youth Organization Community-based Environment
Youth-Serving Organization School-based Health
Faith-based Peace Building & Security
Consortium/Federation Governance
Organizational Level Active Citizenship
Global Mobility
City/Municipal Organization Social Inclusion & Equity
Economic Empowerment
Organizational Contact Number/s Official Organizational Email Address
Telephone/ Cellphone:
Organization Website Organization Facebook Account or Page
Link: Link:
Current Number of Registered Members Date of Establishment of Organization
/ /
ORGANIZATION HEAD INFORMATION
Name of Head of Organization Date of Birth

Family Given Middle

Contact Number / Mobile Number Facebook Account Name or Link:

Email Address: Address:

DATA PRIVACY NOTICE & CONSENT

In compliance with the Data Privacy Act (DPA) of 2012, and its implementing Rules and Regulations (IRR) effective since September 9, 2016, this is to certify that I/we,
authorize Quezon City Youth Development Office (QCYDO) to store and use our data for the purpose of the Youth Organization Registration Program. With this, I
authorize QCYDO to:

1. Use the organization data for the process of local verification, local certification, and registration to the National Youth Commission Youth Organization
Registration Program
2. Access to the form information will be limited to the Quezon City Government (Youth Development Office and Barangay Community Relations Department), its
designated personnel for the assistance, monitoring, research and programs of/for registered youth organization
3. Improper use of the information in this form will be subjected to appropriate actions under the Data Privacy Act of 2012.
4. I understand and assured that the necessary precautions will be taken by the Quezon City Youth Development Office to protect my/our organization data.
I HEREBY CERTIFY that the information provided in this form is complete, true and correct to the best of my knowledge.

Signature over Printed Name Date

SUBMISSION SLIP

Date Received: Received From:

Receiving Location or Office:
Name of Organization:

Documents Submitted
NYC YORP REGISTRATION FORM DIRECTORY OF OFFICERS AND ADVISER LIST OF MEMBER
CERTIFICATE OF ENDORSEMENT IDENTIFICATION CARD OF OFFICERS CONSTITUTION AND BY LAWS
Received by: