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