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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
Page 1 of 1
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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Form-J.pdf

  • 1. Republic of the Philippines Department of Science and Technology SCIENCE EDUCATION INSTITUTE 2024 DOST-SEI SCIENCE AND TECHNOLOGY UNDERGRADUATE SCHOLARSHIPS APPLICATION FORM Page 1 of 1 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 ________________________________