Republic of the Philippines

Department of Science and Technology

SCIENCE EDUCATION INSTITUTE

2024 JUNIOR LEVEL SCIENCE SCHOLARSHIPS

APPLICATION FORM
FORM D – CERTIFICATION OF GOOD HEALTH

TO WHOM IT MAY CONCERN:

This is to certify that __________________________________________________ is of good health and

(Name of Applicant)
N(
is fit to study his/her course in college.

_______________________________________________
Printed Name & Signature of School/Barangay Health
Center/Private Physician/Nurse/Midwife

License No.: _______________________________

Date: _____________________________________

Page 1 of 1