DPO-001-18-00

OUR LADY OF FATIMA UNIVERSITY

Valenzuela City + Quezon City+ Antipolo City + City of San Fernando+ NEDCI

CONSENT AND AUTHORIZATION FORM

The Our Lady of Fatima University respects a person’s right to privacy and the confidentiality of his/her personal
information. By signing, you acknowledge that you have read the Consent and Authorization Form in full and agree to
be bound by and comply with them.
By signing below, I agree with the following:

1. I hereby certify that I have accomplished the application form truthfully and to the best of my knowledge. All data provided are
accurate and updated, and that I submit myself to the University’s administrative and disciplinary sections should there be any
discrepancies or false information in my application and in the documents submitted.

2. I shall abide by all the regulations and policies promulgated by Our Lady of Fatima University as stated in the OLFU handbook and in
the college and/ or department policies.

3. I understand and accept that Our Lady of Fatima University does not recognize any sorority and fraternity, and that initiation
activities (hazing, etc) are strictly prohibited inside and outside of school premises. Any student participating in such activities may
be excluded from the university.

4. The university conducts random drug testing as part of its advocacy in keeping a drug-free and safe academic environment. As a
student, I may be randomly selected to undergo drug testing at any time. I hereby give my consent to participate in a random drug
testing program of the University following accepted protocols. I release Our Lady of Fatima University form any liabilities, claims
and causes of action, known or unknown, contingent or fixed that may result from these tests.

5. I hereby authorize and give voluntary consent to release Our Lady of Fatima University to collect and process the information stated
herein and other personal and academic information as required by the University or as deemed necessary. These may include, but
not limited to, information pertaining to my academic performance, my personal information, my socio-economic profile, and other
sensitive information that might be needed or academic evaluation & monitoring, scholarship grants, financial aid, ethical or
disciplinary proceedings, research, statistical reports and medical evaluation.

6. I hereby give my authorization to the University to process these information according to the policies of the university and to
release such data to any third party to which the University deems necessary for any legal purpose for the furtherance of my
academic, professional and personal development ( such as but not limited to practicum and affiliation partners, possible
recruitment and placement offices, institutional partners, research centers and other such private and government agencies). I
likewise give my consent to the University practice of posting academic performance as needed.

7. I agree, authorize and give my consent to Our Lady of Fatima University to use images and recordings in school activities where I
participated without expectation of compensation or other remuneration. This consent is given in perpetuity, and does not require
my prior approval.

8. I agree to all the terms and conditions stated herein and to all the policies of Our Lady of Fatima University and that my agreement
to all those stated above is among the conditions to my enrollment at the Our Lady of Fatima University.

Note: Please affix your signature over your printed name.

____________________________________ ____________________________________ ___________________________________

Student’s Signature (LN/FN/MI) Parent’s Signature (LN/FN/MI) Guardian’s Signature (LN/FN/MI)

____________________________________ ____________________________________ _________________________________

Date (MM/DD/YYYY) Date (MM/DD/YYYY) Date (MM/DD/YYYY)

Submitted by:

Name of Student (LN/FN/MI)___________________________ Student Number: ______________________

CAMPUS: ___________________________ Date: ______________________