UniFAST TDP Form ANNEX "A"

2020 version (NOT FOR SALE)

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

Acuyong Mark Christian Ramirez

Name (Last Name) (First Name) (Middle Name) Maiden Name
put extension if any ie. Jr., III (for Married Women)
Date of Birth
08/07/1999 Permanent Address Zip Code
(mm/dd/yyyy)
Place of Birth
Las PinasCity 226 Zapote 3 Bacoor Cavite 4102
Street & Barangay Town/City/Municipality Province

Sex ✔Male Female Name of School Last Attended

Cavite State University (Bacoor Campus)
✔Single Widowed School ID Number
18-01-0349
Civil Status Married Separate
School Address Soldiers Hills IV, Molino VI, Bacoor City, Cavite
Others
Citizenship Filipino School Sector (✔)Public ( ) Private

Mobile Number 09566111168 Highest Attained Grade Year Level Tribal Membership
College (if applicable)
E-mail Address Acuyong.mcr@gmail.com Type of Disability
(if applicable)
FAMILY BACKGROUND
Father: (✔) Living () Deceased Mother: (✔) Living () Deceased
Name Hercel D. Acuyong Rhodelia R. Acuyong

Address 226 Zapote 3 Bacoor Cavite 226 Zapote 3 Bacoor Cavite

Occupation None Vendor

Educational Attainment College Garduate Highschool Graduate

Total Parents Gross Income 3500 a month No. of Siblings in the family (3)

School Intended to enroll or enrolled in: Enrolled in

School Address: Soldiers Hills IV, Molino VI, Bacoor City, Cavite

Type of School: (✔ ) Public ( ) Private

Degree Program: BS CRIMINOLOGY
Type Grantee Institution/Agency
Are you enjoying other educational financial assistance?( ✔)Yes or No If yes, please specify 1. yes
Because it can support me when it comes into school assistance
2. yes Because it can support my internet bill
and our other necessary needs
I hereby certify that foregoing statements are true and correct.
Acuyong, Mark Christian R. May,04 2021
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 Documents Attached
groups): ( ) dependent of solo Report Card
parent COR
( ) senior citizens Certified True Copy Of Grades
( ) persons with disabilities. please specify type of disability Latest ITR
( ) Indigenous and ethnic peoples. please specify membership Total

Evaluated Processed by:

UniFAST Regional Coordinator

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