University of the Visayas

STUDENT RECORDS & MANAGEMENT DEPARTMENT

Main Campus Corner D. Jakosalem and Colon Sts., Cebu City 6000 Philippines
Tel Number: (032) 253-6173 Local Number: 211 Email: srmd@uv.edu.ph Website: uv.edu.ph

APPLICATION FOR GRADUATION

Date of Submission :
(Month/Day/Year)

Instructions: Fill out this form legibly, completely, and accurately. Please take note of the following reminders:
1. Prepare all required attachments (i.e., signed clearance) before submitting the form.
2. Fill out the Data Privacy Notice at the back portion of the form.

College/Department :
Program/Degree Applied for :
Date Admitted :
(Month, Year or Semester)
PERSONAL DATA SHEET (Please fill up legibly in capital block letters.)
Student Number: Contact Number: Email Address:

LAST NAME:

FIRST NAME:

MIDDLE NAME:

Date of Birth : Sex: ⬜Male ⬜Female Civil Status:

Place of Birth :
Religion : Citizenship :

Transferee? YES NO If NO, With F137? YES NO Not SURE

If YES, please provide last school attended:

With TOR? YES NO If YES, Remarks? Informative Copy Granted Transfer Credential (GTC)

SUBJECTS PRESENTLY ENROLLED IN

Section Code Subject Code Units Section Code Subject Code Units

IMPORTANT REMINDER: This application for graduation and the dean’s approval should NOT be construed as evidence that the applicant has already finished and
completed all the requirements of the program. This is only for the purpose of processing his/her for application for graduation and not for anything else.

I hereby certify that the foregoing entries are true and correct to the best of my ability and the knowledge and that, I have fully read and understand the
reminders and I further abide by its conditions.
__________________________________________
Applicant’s Signature over Printed Name

Recommended by: Evaluated by: Approved by:

_______________________________ _________________________________ ______________________________

College Dean SRMD Evaluator SRMD Director
Date Signed: Date Signed: Date Signed:
Remarks: ⬜Candidate for Graduation ⬜Not a candidate for Graduation

Received by: ____________________________________ Date Received: __________________

SRMD Records in Charge

F-SRM-010 Rev.0 (08-01-22)

“An internationally recognized private non-sectarian university committed to academic excellence, transformational, and
innovative education” a university with a heart!
Cor. Colon St. & D. Jakosalem St., Cebu City • uv.edu.ph
 University of the Visayas
STUDENT RECORDS & MANAGEMENT DEPARTMENT
Main Campus Corner D. Jakosalem and Colon Sts., Cebu City 6000 Philippines
Tel Number: (032) 253-6173 Local Number: 211 Email: srmd@uv.edu.ph Website: uv.edu.ph

Privacy Notice
This privacy notice outlines the data collection, sharing, confidentiality and data security, retention and disposal policies of the University of the Visayas Inc.
in compliance to Republic Act 10173 otherwise known as the Data Privacy Act of 2012 and then Implementing Rules and Regulations of the National Privacy
Commission.

Collection of Information
The University of the Visayas collects personal information that are necessary and compatible with the declared, specified, and legitimate purposes through
this data gathering form which specifically collects your:

• Personal information (i.e. name, student ID number, permanent address, email address and mobile/phone number);
• Demographic information (i.e. program, major, and year level);
• Contact information of parent/s, legal guardians, and/or authorized representative (name, mobile number, and relationship);

Purpose of Collection
The University of the Visayas collects and uses personal information only as necessary for the purposes which it was obtained. UV may use the personal
information you provided in this form for the purpose of processing the application for graduation.

Data/Information Sharing
The data collected by the University of the Visayas are shared internally for official business purposes only. UV shall not share your personal information
with any third party that intends to use your personal information for commercial purposes unless you have freely given your specific and informed consent.
UV may share your personal information with third parties for other purposes limited to the following circumstances:

Parents and Legal Guardians. UV may disclose your personal information to your parents and legal guardians in the communication of your
academic progress and other such matters that they may inquire concerning you.

Grantors, Benefactors, and Sponsors. UV may share your personal information to private entities and/or government organizations that offer
scholarship privileges. These parties most likely access and further process your personal information in the course of their scholarship evaluation
and documentation.

Legal Requirements. UV may disclose your personal information if it is required to do so by law or it, in UV’s good faith judgment, such legal
disclosure is reasonably necessary to comply with legal processes or respond to any claims.

UV shall ensure that all employees and such third parties, who use data processing facilities or handle personal data, must s ign a confidentiality and non-
disclosure agreement before the works starts or prior to being given access to personal data. Only authorized UV employees having the legitimate purpose
of carrying out their duties will be able to access your data.

Data Security, Retention, and Disposal

Personal data in the custody of the university may be in digital and/or electronic format and paper based. UV ensures that personal data under its custody
are protected against any accidental or unlawful destruction, alteration and disclosure as well as against any other unlawful processing. In order to keep
your personal information secure, UV has implemented a number of security measures which includes keeping data processing forms in a secured cabinet
strictly accessible only to authorized employees of the university. Personal data under the custody of UV will be retained only for as long as it is necessary
for the fulfilment of the purposes which it was collected, considering the need to answer queries and comply with legal requirements under applicable laws.
This means that we retain your personal information for a period of 3 years after your last interaction with us. When the personal information collected are
no longer required, data processing forms containing personal data are shredded or incinerated.

Your Rights
UV recognizes every data subject is entitled to be informed of the processing of his or her personal information and be granted reasonable access to such by
the personal data controller or personal data processor. Other rights include:

• Right to dispute the inaccuracy or error in the personal data

• Right to request the suspension, withdrawal, removal or destruction of personal data; and
• Right to be indemnified for any damages sustained due to inaccurate, incomplete, false, unlawfully obtained or unauthorized use of personal
data.

Contact Us
Data subjects may inquire or request for information regarding any matter relating to the processing of their personal data under the custody of the
University of the Visayas, including the data privacy and security policies implemented to ensure the protection of their personal data, through the
University’s Data Protection Officer:
• Phone @ 253-4384 Local 124
• Email at dpo@uv.edu.ph
• Mail at Data Privacy Office, 2nd Floor Inday Pining Building, University of the Visayas, Colon Street, Cebu City
• Data Privacy Contact Form available in the university website (uv.edu.ph)

ACKNOWLEDGEMENT

By affixing my signature below, I hereby acknowledge that I have read and understood this Privacy Notice; and thus, consent to the collection, processing,
storage, sharing, use, or disclosure by the University of the Visayas Inc. of my Personal Information and/or Sensitive Personal Information, to the extent
that such collection, processing, storage, sharing, use or disclosure are required or necessary to enable the University of the Visayas to comply with their
respective obligations under applicable laws, rules, and regulations.

I declare that the information I have provided in this form is true and correct.
.

Signature Over Printed Name

F-SRM-010 Rev.0 (08-01-22)

“An internationally recognized private non-sectarian university committed to academic excellence, transformational, and
innovative education” a university with a heart!
Cor. Colon St. & D. Jakosalem St., Cebu City • uv.edu.ph