Applicant's Consent (Verification/Authorization)

I knowingly and voluntarily consent to the disclosure and processing of my personal

information and sensitive personal information (disciplinary records and special need,
psycho-emotional condition and physical disability) contained in this application form to
De La Salle-College of Saint Benilde, Antipolo for the purpose of assessing my college
application. This information will be shared with the members of the school’s committee.
I waive my right to inspection and correction of the contents of this recommendation form.

E mail Address: ______________________________________

Surname Name: _______________________________________

First Name: _______________________________________

Middle Name: _______________________________________

School: _______________________________________

School Address: _______________________________________

Years Attended: _______________________________________

Name of Parent or Guardian: _______________________________________

Contact Number of Parent or Guardian: ______________________________________

I voluntarily and knowingly consent to the processing of the information contained

in all the google forms and its disclosure to De La Salle-College of Saint Benilde, Anipolo
for the purpose of assessing my application.

Agree
Disagree

______________________________ _________________

Applicant’s Name and Signature Date