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Form J

The document is an application form for a scholarship program. It requires the applicant and their parent or guardian to declare that all information provided is truthful and complete, and agree to refund any financial benefits if misinformation is discovered. It also authorizes the program to conduct background checks and collect personal data as part of the application process.

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iana tarena
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541 views1 page

Form J

The document is an application form for a scholarship program. It requires the applicant and their parent or guardian to declare that all information provided is truthful and complete, and agree to refund any financial benefits if misinformation is discovered. It also authorizes the program to conduct background checks and collect personal data as part of the application process.

Uploaded by

iana tarena
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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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
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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