CONSENT FORM

I hereby authorize the Department of Science and Technology-Science Education Institute to

collect, record, and organize my grades and other pertinent personal information from my
school/university in connection with my application to the 2021 DOST-SEI Science and
Technology Undergraduate Scholarships.

I recognize my right to be informed, object to processing, access and rectify, suspend or

withdraw my 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 2021 and its corresponding
implementing Rules and Regulations.

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Signature Over Printed Name of Applicant

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Date

Noted by:

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Signature Over Printed Name of Parent

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Date