Republic of the Philippines

Department of Science and Technology

SCIENCE EDUCATION INSTITUTE

2023 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)

health and is fit to study in college.

_______________________________________
Printed Name & Signature

Designation ____________________________
(i.e., Private Physician, Nurse, Barangay Health Center)

License No. ____________________________

Date _________________________________

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