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2020 Junior Level Science Scholarships Online Application Form
2020 Junior Level Science Scholarships Online Application Form
good moral character, there having no disciplinary action taken against him/her as of the date of application.
_______________________________________________
Printed Name & Signature of Dean of Student Affairs
Date: __________________________________________
NOTE: Failure to maintain good moral character before the award of the scholarship shall cause forfeiture thereof. DOST-SEI may require another certification before the signing of the
Scholarship Agreement should the applicant qualify.
_______________________________________________
Printed Name & Signature of School/Barangay Health
Center/Private Physician/Nurse
License No.: ____________________________________
Date: __________________________________________
Information Technology
Bachelor of Science in _______________________________________________________________ as a REGULAR SECOND YEAR student
(Program of Study)
_______________________________________________
Printed Name & Signature of College Dean/Registrar
Date: __________________________________________
NOTE: Potential qualifiers to the JLSS Scholarship Program will be required to submit a certification of Regular Third Year Standing in AY 2020-2021; proper notification will be
sent sometime in July – August 2020. Awarding of the scholarship shall be pending the submission of this requirement.
_______________________________________________
Printed Name & Signature of Barangay Official/Principal
Date: _________________________________________
FORM G1 – COMMITMENT TO RETURN OF SERVICE (For RA 7687 and MERIT Applicants only)
This is to certify that the undersigned AGREES to render service in the country preferably along the field of specialization, on a full-time
basis for a minimum period equivalent to the duration of the scholarship.
Taken the DOST-SEI Undergraduate Examination but did not qualify for the scholarship.
Qualified for the DOST-SEI Undergraduate Scholarship but did not avail of the award.
Applicant’s Signature
Over Printed name _________________ Date Signed _________________