University of Southeastern Philippines
College of Education
Transaction Form for Enrollment
Date: 19 January 2021
Pursuant to the University of Southeastern Philippines (USeP) data privacy policy and the Data
Privacy Act of 2012, we will collect and process the following personal information from you when you
manually or electronically fill in this form:
ID No.:
Last Name:
First Name:
Middle Name:
Program/Course:
Year Level:
Contact No.:
Provide details of information you are needing in the box provided below.
USE: The collected personal information will be utilized solely for enrolment purposes.
PROTECTION MEASURE: These personal information shall be held in utmost confidentiality and
shall not be transferred or divulged to other persons or entity without your express consent. Only
authorized personnel has access to this personal information. The University will only retain the
collected personal data as long as necessary for the fulfilment of the purpose.
CONSENT
[ ] I AGREE to the collection and processing of my personal information.
[ ] I DO NOT AGREE with the collection and processing of my personal information.
INFORMATION
For queries pertaining to the University Data Privacy Policy and with the Data Privacy Act of 2012,
you may contact the University Data Privacy Officer ASST. PROF. KARLO MARTIN C.
CARAMUGAN through his email kmccaramugan@usep.edu.ph.
PRE-REGISTRATION FORM
_________________________________________________________________________________________________________
WE BUILD DREAMS WITHOUT LIMITS
Address: University of Southeastern Philippines Telephone: (082) 227-8192 local 224
Iñigo St., Bo. Obrero, Davao City Website: www.usep.edu.ph
Philippines 8000 E-mail: ced@usep.edu.ph
University of Southeastern Philippines
College of Education
NAME: ID No.:
COURSE: Major:
[ ] 1st Sem School Year Sex Type Scholarship
[ ] 2nd Sem 2020-2021 [ ] Male [ ] Old Student Kindly indicate:
[ ] Off Sem [ ] Female [ ] New Student
[ ] Transferee
Subject ID Subject Description Units Days Time Room
CHECK THE BOX TO INDICATE THE TYPE OF STUDENT:
NON-PAYING STUDENT (Students who avail the free tuition and other benefits under RA
[ ] 10931 and commit to comply with the return service under the act.)
[ ] PAYING STUDENT (Students who voluntarily opt out of the free higher education provision.)
[ ] PAYING STUDENT (18 years old above)
I hereby declare that, as a parent of a minor, I am fully aware of the Republic Act 10931 (Universal
Access to Quality Tertiary Education of 2017) and all the privileges and responsibilities accorded
and mandated to my child under this Act. However, my child voluntarily opts out of the free higher
education provision. Thus, I hereby agree that my child shall waive all the benefits for the Second
Semester of School Year 2020-2021 for the reason that we are capable of paying for his/her tuition
and other related school fees.
Signature over Printed Name of Date
Parent/Guardian
Approved:
Student’s Signature VELMA S. LABAD
Dated Signed: Signature over Printed Name of Program
Head/Adviser
Student Mobile #: Date Signed: 19 January 2021
DATA PRIVACY PROVISION and CONFIDENTIALITY
and NON-DISCLOSURE STATEMENT
_________________________________________________________________________________________________________
WE BUILD DREAMS WITHOUT LIMITS
Address: University of Southeastern Philippines Telephone: (082) 227-8192 local 224
Iñigo St., Bo. Obrero, Davao City Website: www.usep.edu.ph
Philippines 8000 E-mail: ced@usep.edu.ph
University of Southeastern Philippines
College of Education
It is expressly understood by the Undersigned that in the process of my admission to the
University of Southeastern Philippines (USeP), the latter may collect data and information of students
it deemed needed for the latter’s admission to the University.
In view of this, the Undersigned agrees to allow, authorize, or give permission to USeP to
gather, collect, handle, keep and manage such data or information, as provided to them by the
Undersigned while being a student in the instant University.
Further, it is also expressly understood by the Undersigned that while enrolled in the
University, the Undersigned may be exposed to data or information which may be deemed as
classified by USeP. It is therefore imperative for the Undersigned to hold in confidence any such data
or information and shall undertake to prevent its disclosure or transfer, consciously or unconsciously,
to any party outside of this agreement without the knowledge and written consent of USeP.
By affixing my signature, the Undersigned hereby agrees with the foregoing conditions and
subscribe to USeP’s virtue of upholding the fundamental human right to privacy, in compliance to
Republic Act 10173 or the Data Privacy Act of 2012.
Signed this 19th day of January, 2021.
Signature over Printed Name
_________________________________________________________________________________________________________
WE BUILD DREAMS WITHOUT LIMITS
Address: University of Southeastern Philippines Telephone: (082) 227-8192 local 224
Iñigo St., Bo. Obrero, Davao City Website: www.usep.edu.ph
Philippines 8000 E-mail: ced@usep.edu.ph
