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Farmer-Dependent Scholarship Form

This document is an application form for a universal scholarship program for farmer-dependent students for the 2021-2022 academic year. It requests personal information about the applicant such as name, address, family background, educational background, and contact details. It also lists the required documents for the application such as birth certificates, school records, and enrollment certificates. The form notes that personal data collected will only be used for application processing, announcements, and establishing relations between applicants and administrators in accordance with data privacy laws. Applicants must sign to consent to their personal data being collected and used for these specified purposes.

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193 views2 pages

Farmer-Dependent Scholarship Form

This document is an application form for a universal scholarship program for farmer-dependent students for the 2021-2022 academic year. It requests personal information about the applicant such as name, address, family background, educational background, and contact details. It also lists the required documents for the application such as birth certificates, school records, and enrollment certificates. The form notes that personal data collected will only be used for application processing, announcements, and establishing relations between applicants and administrators in accordance with data privacy laws. Applicants must sign to consent to their personal data being collected and used for these specified purposes.

Uploaded by

kiminooo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ATTACH PICTURE

UNIVERSAL SCHOLARSHIP PROGRAM


APPLICATION FORM FOR FARMER-DEPENDENT
ACADEMIC YEAR 2021 TO 2022
DEADLINE OF APPLICATION: AUGUST 27, 2021

Instruction: Fill in all required information. Do not leave any item blank. If item is not applicable indicate “N/A”.

Enrolled Course and School


Enrolled Course: Name of School:

Major: Address:

Personal Information
Family Name First Name Middle Name

Date of Birth Age Civil Status Place of Birth

Contact Number E-mail Address

Permanent Address

Present Address

Family Background
Father Mother

Birth Date Birth Date

Occupation Occupation

Name of Registered Farmer Year(s) Registered with ULPI

Complete Name Birth Date Age Occupation

Sibling(s)

Educational Background
Year
Grade / Level /Academic Strand Name of School Honors / Awards
Graduated
CHECKLIST OF REQUIRED DOCUMENTS (This part is for USP Administrators use only)

Accomplished USP Application Form with 2x2 I.D. Picture

PSA-Authenticated Certificate of Live Birth

Certificate of Good Moral Character and/or Honorable Dismissal

Senior High School Certified true copy of Report Card (Form No. 137) or Transcript of Records (Form No. 138)

Certificate of Enrollment or Certificate of Registration

The USP Administrators recognize their responsibilities under the Republic Act No. 10173 (Act), also known as the Data Privacy Act of 2012, with respect
to the data they collect, record, organize, update, use and consolidate from applicants. The personal data obtained from this form is entered and stored
within the company’s information storage system and will only be accessed by USP Administrators and other authorized personnel of the company.

Furthermore, the information collected in this form shall only be used for the following purposes:

1. Evaluation, processing and reporting of documents related to the applicants;


2. Announcements / promotions of programs, courses and other activities offered / organized by the USP Administrators.
3. Activities pertaining to establishing relations within applicants/scholars and the administrators.

USP Administrators shall not disclose the applicant/scholar’s personal information without their consent and shall retain this information.

APPLICANT/SCHOLAR CONSENT:

I have read the Universal Scholarship Program and express my consent for the USP Administrators, to collect, record, organize, update or modify, retrieve,
consult, use and consolidate my personal data as part of my information.

I hereby affirm my right to be informed, object to processing, access and rectify, suspend or withdraw my personal data and be indemnified in case of
damages pursuant to the provisions of the Republic Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its corresponding Implementing Rules
and Regulations.

Signature over Printed Name of Applicant Date Accomplished/Submitted

This part is for USP Administrators use only

Signature over Printed Name of USP Administrator Date of Receipt

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