FLP Esmel Fellowship Program 2022 2023 Application Form

Esmel Fellowships
Academic Year 2022–2023
Application Form
Please attach a recent 2” x 2” ID photo and accomplish this form on a legal size bond paper.
PERSONAL DETAILS
Name: _______________________________________________________________________________
(Surname) (First Name) (Middle Name)
Present Address:
______________________________________________________________________________________
_____________________________________________________________________________ Zip Code: ______________________________
Permanent Address: _____________________________________________________________________________________________________
_____________________________________________________________________________ Zip Code: ______________________________
School: ______________________________________________________________________ Year Level: _______________________________
School Mailing Address: _________________________________________________________________________________________________
_____________________________________________________________________________ Zip Code: ______________________________
Email Address: _______________________________ Mobile No.: __________________________ Landline No.: ___________________
Place of Birth: ________________________________ Date of Birth: _________________________ Age: ___________________________
Gender: _____________________________________ Civil Status: ___________________________ Religion: _______________________
I hereby submit my essay titled:
_______________________________________________________________________________________________________________________
MAJOR ACHIEVEMENTS
Please list all prizes, awards, medals, etc. you have been granted. You may use a separate sheet of paper. Please note that you may be required to provide evidence.
1. ______________________________________________________________________________________________________________________
2. ______________________________________________________________________________________________________________________
3. ______________________________________________________________________________________________________________________
ORGANIZATIONS Position Year/s
_______________________________________________________ _________________________________________ ___________________
_______________________________________________________ _________________________________________ ___________________
_______________________________________________________ _________________________________________ ___________________
DECLARATION You may use a separate sheet of paper for the above.
I hereby agree to abide by the terms and conditions as provided in the FLP Esmel Fellowship
Program Rules for the School Year 2022–2023. I certify that all the above information I provided are
true and complete to the best of my knowledge.
I also understand that this submission of my application does NOT automatically qualify me
for the fellowship grant and that I will abide by the decision of the FLP Esmel Fellowships Board of
Judges.
_________________________________________
(Signature)
Date: ____________________________________
3/F PCCI Corporate Centre, 118 L.P. Leviste Street, Salcedo Village, Makati City 1227 Philippines
Tel No.: +632 8553 1102 | Email: [email protected] | Website: www.libpros.com
DATA PRIVACY STATEMENT AND CONSENT
The Foundation for Liberty and Prosperity, Inc. (FLP) values your privacy
and recognizes its responsibility under the Republic Act No. 10173 (Data Privacy
Act of 2012), with respect to the data it collects, records, organizes, updates, uses,
consolidates or destructs from program applicants, awardees, and donors. The
personal data obtained is entered and stored within FLP’s authorized information
and communications system and will only be accessed by FLP authorized
personnel. The FLP has instituted appropriate organizational, technical and
physical security measures to ensure the protection of the program
applicants’/awardees’/donors’ personal data.
Furthermore, the information collected and stored by FLP shall only be used
for the following purposes:
1. Processing and reporting related to FLP programs, i.e., program status

and accomplishment reports, quarterly and annual reports, preparation
of reports;
2. Announcements/promotions of events, press releases, programs, and
other activities organized by the FLP and its partners; and
3. Activities pertaining to establishing relations with awardees, donors and
friends of FLP.
FLP shall not disclose the program applicants’, awardees’, and donors’
personal information without their consent and shall retain this information in its
records for the effective implementation and management of its programs.
CONSENT:
I have read FLP’s Data Privacy Statement and express my consent for the
Foundation for Liberty and Prosperity, Inc. (FLP) to collect, record, organize,
update or modify, retrieve, consult, use, consolidate, block, erase or destruct my
personal data as part of my information.
I agree that my name, photos or videos may be taken and published in FLP’s
publications, newsletters and press releases, including but not limited to TV, radio
and print advertisements and coverage, and internet social media accounts.
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

Applicant
Date _____________________ 2023
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Esmel Fellowships

Academic Year 2022–2023

_____________________________________________________________________________ Zip Code: ______________________________

Permanent Address: _____________________________________________________________________________________________________

_____________________________________________________________________________ Zip Code: ______________________________

School: ______________________________________________________________________ Year Level: _______________________________

School Mailing Address: _________________________________________________________________________________________________

_____________________________________________________________________________ Zip Code: ______________________________

Email Address: _______________________________ Mobile No.: __________________________ Landline No.: ___________________

Place of Birth: ________________________________ Date of Birth: _________________________ Age: ___________________________

Gender: _____________________________________ Civil Status: ___________________________ Religion: _______________________

I hereby submit my essay titled:

ORGANIZATIONS Position Year/s

_______________________________________________________ _________________________________________ ___________________

_______________________________________________________ _________________________________________ ___________________

_______________________________________________________ _________________________________________ ___________________

1. Processing and reporting related to FLP programs, i.e., program status

I hereby affirm my right to be informed, object to processing, access and

Signature over printed name

Date _____________________ 2023

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