Information and Consent Form-AWS data

Information and Consent Form

Kindly fill up all the information needed below to proceed.
Consent statement of information collection privacy

Project LIGTAS: By filling out this form, you are giving Project LIGTAS the permission to process and store your personal information in accordance with Republic Act 10173 or the Data Privacy Act of 2012.
Date
Fullname*

First NameMiddle NameLast Name
Contact number*
Gender*
Email*
example@example.com
Affiliation*

StudentEmployeeGoverment employeeScientistResearcherOther
Title/Job*
Department/Organization
Address*
Company, University/School, Goverment Agencies
Purpose of data*
example; research study etc.
Select LIGTAS AWS source*
Data parameters*
Collected data from*

MonthDayYear
Date
Collected data to*

MonthDayYear
Date
Notes:
Should be Empty: