Republic of the Philippines
Department of Science and Technology
SCIENCE EDUCATION INSTITUTE
2024 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM
FORM J - SIGNED DECLARATION OF APPLICANT AND THE PARENT/LEGAL GUARDIAN
We, the Applicant and my Parent/Legal Guardian/Spouse, hereby certify to the truthfulness and
completeness of information provided. Any misinformation, misrepresentation or withholding of
information will automatically disqualify me/our son/daughter/my spouse from the Department
of Science and Technology-Science Education Institute (DOST-SEI) Scholarship Program. We
are also willing to refund all the financial benefits received plus the appropriate interest if such
misinformation is discovered after my/our child/spouse accepted the award.
In connection with this application for scholarship, we hereby authorize the DOST-SEI
designated representative to conduct a background check on our socio-economic status and to visit
our family dwelling.
Moreover, we hereby express our consent for the DOST-SEI to collect, record, organize, update
or modify, retrieve, consult, use, consolidate, block, erase or destruct our personal data as part of our
information. We hereby affirm our right to be informed, object to processing, access and rectify,
suspend or withdraw our 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.
________________________________
Applicant’s Signature over Printed Name
Date ____________________________
_________________________________
Parent/Legal Guardian/Spouse Signature over Printed Name
Date ________________________________
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Republic of the Philippines
Department of Science and Technology
SCIENCE EDUCATION INSTITUTE
2024 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM
FORM I – APPLICANT’S CERTIFICATION OF NO POST-SECONDARY UNITS
EARNED
This is to certify that the undersigned has NOT earned any college or post-high school vocational
units and will not earn the same in AY 2023-2024.
_____________________________________
Printed Name & Signature of Applicant
Date ________________________________
Noted by: _______________________________________
Printed Name & Signature of Parent/Guardian/Spouse
Date _________________________________
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Republic of the Philippines
Department of Science and Technology
SCIENCE EDUCATION INSTITUTE
2024 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM
FORM H – DOST-SEI SCHOLARSHIP EXAMINATION/AWARD
This is to certify that the undersigned has: (check appropriate box)
NOT applied for a DOST-SEI scholarship before;
Applied for a DOST-SEI scholarship before but did not qualify for the scholarship.
Qualified for the DOST-SEI Undergraduate Scholarship but did not avail of the award.
_____________________________________
Printed Name & Signature of Applicant
Date ________________________________
Noted by: _______________________________________
Printed Name & Signature of Parent/Guardian/Spouse
Date _________________________________
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Republic of the Philippines
Department of Science and Technology
SCIENCE EDUCATION INSTITUTE
2024 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM
FORM G – PARENT'S CERTIFICATION
This is to certify that my son/daughter/spouse, _________________________________________,
(Name of Applicant)
has no pending application for immigration to the USA or any other country.
________________________________________
Printed Name & Signature of Parent/Legal Guardian/Spouse
Date ____________________________________
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Republic of the Philippines
Department of Science and Technology
SCIENCE EDUCATION INSTITUTE
2024 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM
FORM F – CERTIFICATE OF RESIDENCY
TO WHOM IT MAY CONCERN:
This is to certify that __________________________________________ is a bonafide resident
(Name of Applicant)
of ____________________________________________________________ for less than 4 years.
(House No./Unit No./Lot/Block/Bldg., Compound/Street/Phase/Purok, Village/Subdivision, Barangay, City/Municipality, Province) 4 years or more.
(Check appropriate box)
_________________________________________
Printed Name & Signature of Barangay Official/Principal
Date ____________________________________
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Republic of the Philippines
Department of Science and Technology
SCIENCE EDUCATION INSTITUTE
2024 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM
FORM E1 – PRINCIPAL'S CERTIFICATION (For Applicant from the STEM Strand)
TO WHOM IT MAY CONCERN:
This is to certify that ____________________________________ is a member of the Grade 12
(Name of Applicant)
graduating/graduated class under the STEM Strand of the ______________________________________
(Name of School/Address)
for SY ______________.
_______________________________________
Printed Name & Signature of Principal
Date __________________________________
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Republic of the Philippines
Department of Science and Technology
SCIENCE EDUCATION INSTITUTE
2024 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM
FORM D – CERTIFICATION OF GOOD HEALTH
TO WHOM IT MAY CONCERN:
This is to certify that ___________________________________________________ is of good
(Name of Applicant)
N
health and is fit to study in college.
_______________________________________
Printed Name & Signature
Designation ____________________________
(i.e., Private/Barangay Health Center Physician/Nurse/Midwife)
License No. ____________________________
Date _________________________________
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Republic of the Philippines
Department of Science and Technology
SCIENCE EDUCATION INSTITUTE
2024 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM
FORM C – CERTIFICATE OF GOOD MORAL CHARACTER
TO WHOM IT MAY CONCERN:
This is to certify that ___________________________________________________________
(Name of Applicant)
has consistently maintained good moral character, there having no disciplinary action taken against
him/her as of the date of application.
___________________________________________
Printed Name & Signature of Principal/Guidance Counselor
Date: ______________________________________
NOTE: Should the Applicant be considered a potential qualifier, failure to maintain good moral character before
the scholarship is awarded may be a cause for disqualification. DOST-SEI may require another
Certification of Good Moral Character.
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