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 ____
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
DALIGCON RIENALYN DULDULAO DUMLAO
Name (Last Name) (First Name) (Middle Name) Maiden Name
put extension if any ie. Jr., III (for Married Women)

Date of Birth 09/24/1994

(mm/dd/yyyy) PUROK 7 Zip Code

Place of Birth RIZAL, KALINGA BABALAG EAST 3808

RIZAL KALINGA
Street & Barangay Town/City/Municipality Province

Sex Male X Female Name of School Last Attended AMA ONLINE EDUCATION QUEZON CITY
Single Widowed School ID Number
Civil Status X Married Separate
School Address QUEZON CITY
Others
Citizenship FILIPINO School Sector ( ) Public (X ) Private

Mobile Number 09356834429 Highest Attained Grade Year Level 1ST year college Tribal Membership
(if applicable)
E-mail Address Daligconrienalyn24@gmail.com Type of Disability N/A N/A
(if applicable)
FAMILY BACKGROUND
Father: () Living () Deceased Mother: () Living () Deceased

Name ROLANDO DOMINGO DULDULAO REGINA JULIAN DUMLAO

Address BABALAG EAST, RIZAL, KALINGA BABALAG EAST, RIZAL, KALINGA
Occupation FARMER OVERSEAS FILIPINO WORKER
Educational Attainment ELEMENTARY LEVEL HIGHSCHOOL LEVEL
Total Parents GrossIncome 180,000.00 No. of Siblings in the family 4

School Intended to enroll or enrolled in: AMA COMPUTER COLLEGE- TUGUEGARAO CITY
School Address: 37 Caggay Highway TUGUEGARAO CITY(Capital, 3500 Cagayan
Type of School:() Public(X) Private
Degree Program: __ BACHELOR OF SCIENCE IN INFORMATION TECHNOLOGY
Type Grantee Institution/Agency
Are you enjoying other educational financial assistance? __Yes or X No If yes, please specify 1.______ _____________________________
2. ______ _____________________________
I hereby certify that foregoing statements are true and correct.

RIENALYN D. DALIGCON MAY 28, 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 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 UniFASTMemorandum 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
currentlyenrolled 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 mustbe
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
DOCUMENTARY REQUIREMENTS per Section 6 of the UniFAST Memorandum Circular No. 02 s. 2021.
6.2.1ACADEMIC 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 OverseasFilipino Workers and seafarers;
b. Case Study prepared and issued by the Municipal Social Welfare andDevelopment Officer who must be a
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.
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 notemployed.