CONSENT FORM

 
I hereby authorize the Department of Science and Technology-Science Education
Institute to collect, record, and organize my grades and other pertinent personal
information from my school/university in connection with my application to the 2021
DOST-SEI Science and Technology Undergraduate Scholarships.
 
I recognize 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.
 
 
NOVA JANE ORIACEL EDRAD _
Signature Over Printed Name of Applicant
 
MARCH 15, 2021 _
   Date
 
Noted by:
 
JACKIELYN O. EDRAD _
Signature Over Printed Name of Parent
 
MARCH 15, 2021 _
   Date