The document contains forms that are part of an application for undergraduate scholarships from the Department of Science and Technology - Science Education Institute (DOST-SEI) in the Philippines.
Form C contains a certificate of good moral character that must be signed by the applicant's principal or guidance counselor. Form D contains a certification of good health that must be signed by a medical professional. Forms E1 and E2 require certifications from the principal regarding the applicant's enrollment in a STEM or non-STEM strand. Form F addresses residency requirements. Forms G through I contain certifications that must be signed by the applicant and parent/guardian regarding application details, consent for background checks, and agreement to the
The document contains forms that are part of an application for undergraduate scholarships from the Department of Science and Technology - Science Education Institute (DOST-SEI) in the Philippines.
Form C contains a certificate of good moral character that must be signed by the applicant's principal or guidance counselor. Form D contains a certification of good health that must be signed by a medical professional. Forms E1 and E2 require certifications from the principal regarding the applicant's enrollment in a STEM or non-STEM strand. Form F addresses residency requirements. Forms G through I contain certifications that must be signed by the applicant and parent/guardian regarding application details, consent for background checks, and agreement to the
The document contains forms that are part of an application for undergraduate scholarships from the Department of Science and Technology - Science Education Institute (DOST-SEI) in the Philippines.
Form C contains a certificate of good moral character that must be signed by the applicant's principal or guidance counselor. Form D contains a certification of good health that must be signed by a medical professional. Forms E1 and E2 require certifications from the principal regarding the applicant's enrollment in a STEM or non-STEM strand. Form F addresses residency requirements. Forms G through I contain certifications that must be signed by the applicant and parent/guardian regarding application details, consent for background checks, and agreement to the
The document contains forms that are part of an application for undergraduate scholarships from the Department of Science and Technology - Science Education Institute (DOST-SEI) in the Philippines.
Form C contains a certificate of good moral character that must be signed by the applicant's principal or guidance counselor. Form D contains a certification of good health that must be signed by a medical professional. Forms E1 and E2 require certifications from the principal regarding the applicant's enrollment in a STEM or non-STEM strand. Form F addresses residency requirements. Forms G through I contain certifications that must be signed by the applicant and parent/guardian regarding application details, consent for background checks, and agreement to the
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: Failure to maintain good moral character before the award of the scholarship shall cause forfeiture thereof. DOST-SEI may require another certification before the signing of the Scholarship Agreement should the applicant qualify.
Page 1 of 1 Republic of the Philippines Department of Science and Technology SCIENCE EDUCATION INSTITUTE
2022 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 of School/Barangay Health Center/Private Physician/Nurse
License No. ____________________________
Date _________________________________
Page 1 of 1 Republic of the Philippines Department of Science and Technology SCIENCE EDUCATION INSTITUTE
2022 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 class under the STEM Strand of the _________________________________________
(Name of School/Address)
for SY 2021-2022.
_______________________________________ Printed Name & Signature of Principal
Date __________________________________
FORM E2 – PRINCIPAL'S CERTIFICATION (For Applicant from the NON-STEM Strand)
TO WHOM IT MAY CONCERN:
This is to certify that ______________________________________ is a member of the Grade 12
(Name of Applicant)
graduating class under the NON-STEM Strand for the SY 2021-2022 and is classified within the
upper five percent of _______ students in the graduating class
(Total Number of Graduating Students) .
________________________________ NOTE: Please certify based on Applicant’s academic Printed Name & Signature of Principal standing as of Grade 11 (i.e. Top 5% of his/her class) Date ___________________________
Page 1 of 1 Republic of the Philippines Department of Science and Technology SCIENCE EDUCATION INSTITUTE
2022 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.
(Permanent Address) 4 years or more. (Check appropriate box)
_________________________________________ Printed Name & Signature of Barangay Official/Principal
Date ____________________________________
Page 1 of 1 Republic of the Philippines Department of Science and Technology SCIENCE EDUCATION INSTITUTE
2022 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM
FORM G – PARENT'S CERTIFICATION
This is to certify that my son/daughter, _____________________________________________,
(Name of Applicant)
has no pending application for immigration to the USA or any other country.
________________________________________ Printed Name & Signature of Parent or Legal Guardian
Date ____________________________________
Page 1 of 1 Republic of the Philippines Department of Science and Technology SCIENCE EDUCATION INSTITUTE
2022 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM
FORM H – APPLICANT’S CERTIFICATION
This is to certify that the undersigned has (Check all that apply):
1. NOT taken any previous DOST-SEI Undergraduate Scholarship examination.
2. Taken the DOST-SEI Undergraduate Examination but did not qualify for the scholarship.
3. Qualified for the DOST-SEI Undergraduate Scholarship but did not avail of the award.
4. NOT earned any post-secondary or undergraduate units.
_____________________________________ Printed Name & Signature of Applicant
Date ________________________________
Noted by: _______________________________________
Printed Name & Signature of Parent or Guardian
Date _________________________________
Page 1 of 1 Republic of the Philippines Department of Science and Technology SCIENCE EDUCATION INSTITUTE
2022 DOST-SEI SCIENCE AND TECHNOLOGY
UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM FORM I - SIGNED DECLARATION OF APPLICANT AND THE PARENT/LEGAL GUARDIAN
We, the Applicant and my Parent/Legal Guardian, hereby certify to the truthfulness and completeness of information provided. Any misinformation, misrepresentation or withholding of information will automatically disqualify me/our son/daughter from the 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 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 Science Education Institute of the Department of Science and Technology (SEI-DOST) 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 ____________________________
_________________________________ OR ___________________________________ Father/Mother’s Signature over Printed Name Legal Guardian’s Signature Over Printed Name
Date ________________________________ Date __________________________________
