Office of The Registrar: Data Privacy Statement

Republic of the Philippines
Province of Cebu
CONSOLACION COMMUNITY COLLEGE
OFFICE OF THE REGISTRAR
Municipality of Consolacion
(032)512-6743
DATA PRIVACY STATEMENT
Pursuant to Republic Act No. 10173 or the Data Privacy Act of 2012 (DPA), the Office of the
Registrar of Consolacion Community College acknowledges its responsibilities with regard to data
processing, from collection to destruction and further ensuring that all informations of the data subjects
(students) are processed in observance to the general principles of transparency, legitimacy, and
proportionality.
Further, the Office recognizes the rights of the students to: a.) be informed, b.) object, c.) access,
d.) correct, and e.) rectify, erase and/or block any data provided.
Furthermore, the personal data collected from the data subjects is processed, entered and stored
indefinitely within the College’s authorized systems and process for documentation and program
administration and will only be accessed by authorized personnel.
Declaration of Consent:
In view of the foregoing and in connection with my enrollment with Consolacion Community
College (CCC), I, _______________________________ , hereby give my consent to CCC to collect, use,
store, update, process, disclose my personal data declared to the college as requested or required by its
proper authorities and subsidiaries.
I acknowledge and approve by submitting this form, to have photographs taken during any
college organized events/activities. The college may use or share such photographs with its members and
staff for newsletter, yearbook, email communications, marketing and/or online publications, and for any
other legitimate purpose and intent of the college.
Further, I expressly give my consent to CCC to process, use and disclose to my parent/s and/or
guardian listed below, the following information relative to my education such as grades, program
enrolled, year level, and subject/s taken.
(Please check any or all boxes and fill out.)

Father’s Name : _________________________________________
Mother’s Name : _________________________________________
Guardian’s Name : _________________________________________
_______________________________________
Student’s Signature over Printed Name & Date Signed
Parent’s Consent (for students below 18 years old)
(If guardian, submit a Special Power of Attorney)
___________________________________________
Parent’s/ Guardian’s Signature over Printed Name & Date Signed
Republic of the Philippines
Province of Cebu
CONSOLACION COMMUNITY COLLEGE
Municipality of Consolacion
(032)512-6743
___________________________________________________________________________________
STUDENT INFORMATION SHEET
School of ________________________
Academic Year: ___________________ First Sem Second Sem Summer

Student No. : ___________________
NAME:
______________________________________________________________________________________________
(Family Name) (First Name) (Middle Name)
Program/Course: ____________________________________ Major: ___________________________
Personal Data:
Present Address:
_______________________________________________________________________________________________
Permanent Address:
_______________________________________________________________________________________________
Gender: _________________________ Civil Status _______________ Religion __________________________
Date of Birth: ______________________________ Place of Birth: ______________________________________
Contact Number(s): _________________________ E-mail Address: ___________________________________
Education Information:
Name of School and Address Academic Year Graduated
Elementary :
Junior High :
Senior High :
College (if Applicable):
Family Information:
Name Contact Number E-mail Address

Father:
Mother:
Guardian:
Spouse (if married):
Person to notify in case of emergency:

Name: _________________________________________________ Relationship: ___________________________
Address: ________________________________________________ Contact Number: ________________________
Scholarship/Grants (Applied/Received)
Name of Scholarship/Grant Sponsoring Agency Status
___________________________________
Signature over Printed Name & Date Signed
IMPORTANT REMINDER: All documents (original or authenticated) submitted for enrollment shall become part of the student’s
permanent record and shall be kept in the school files.

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Republic of the Philippines

DATA PRIVACY STATEMENT

(Please check any or all boxes and fill out.)

Academic Year: ___________________ First Sem Second Sem Summer

Program/Course: __________ Major: _

Gender: _________________ Civil Status _ Religion ____________________

Date of Birth: Place of Birth: ________

Contact Number(s): _ E-mail Address: ___________

Name Contact Number E-mail Address

Person to notify in case of emergency:

Name of Scholarship/Grant Sponsoring Agency Status

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