Republic of the Philippines

Department of Science and Technology

SCIENCE EDUCATION INSTITUTE

2021 JUNIOR LEVEL SCIENCE SCHOLARSHIPS

APPLICATION FORM
FORM H – APPLICANT’S CERTIFICATION

This is to certify that the undersigned has:

NOT taken any previous DOST-SEI examination.

Taken the DOST-SEI Undergraduate Examination but did not qualify for the scholarship.

Qualified for the DOST-SEI Undergraduate Scholarship but did not avail the award.

_____________________________________
Printed Name & Signature of Applicant

Date: ________________________________

Noted by: _____________________________________

Printed Name & Signature of Parent

Date: ________________________________

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