TERMS OF AGREEMENT

In confirming my slot for enrollment as a student of the Ateneo De Manila University, I acknowledge
that I have read and understood its applicable Privacy Policy, and that, in addition to those it already
lays down, I also authorize the school to use, share, disclose, or transfer my personal data for the
following purposes:

Providing possible donors/benefactors, upon their request, my personal data, as laid

out in my Scholarship/Financial Aid Questionnaire for the purpose of obtaining
scholarship grants and assessing my applications. Such information, together with
those featured in my Ateneo grade report, may also be relayed to my actual
donors/benefactors during regular reports.
Sharing my directory information with student organizations recognized and
regulated by the University to allow them to communicate and/or promote their
school-related activities. Directory information shall consist of my name, email
address, mobile number, telephone number, year level and course.

I understand that all access, sharing, disclosures, or transfers of personal data shall be governed by
appropriate access restriction policies and other University policies that aim to ensure the
confidentiality and/or security of such data.

By providing personal data to the University, I am confirming that the data is true and correct. I
understand that the University reserves the right to revise any decision made on the basis of the data I
provide should any or all of such data be found to be untrue or incorrect. Any false information or
omission of any information which I am required to disclose to the University constitute sufficient
grounds for the revocation of my application, admission, or enrolment. I likewise confirm that in
supplying the personal data of other individuals, I have obtained their consent in accordance with the
applicable provisions of the Data Privacy Act of 2012.

Please check the appropriate statement:

I am over 18 years of age. I have read this Agreement and agree to be bound by it.
I am the parent/ legal guardian of the student who is a minor (below 18 years old). On
his or her behalf, I have read this Agreement and agree to be bound by it.

___________________________________ ___________________________________
Signature of Applicant Signature of Applicant / Legal Guardian
Over Printed Name Over Printed Name

____________________________ ____________________________
Date Date

G/F Kostka Hall, Katipunan Ave, Loyola Heights, 1108 Quezon City, Philippines
+63 2 426 6001 ext 5154 to 5155 • Fax +63 2 426 1214 • admissions.ls@ateneo.edu