XINGNAN PRIMARY SCHOOL

5 Jurong West Street 91, Singapore 649036

Tel: 67913679, 67927163

Fax: 67921493

Email:

Website: www.xingnanpri.moe.edu.sg

EDUSAVE CHARACTER AWARD – NOMINATION FORM

(FOR PRIMARY 4 - 6)

Name of classmate/schoolmate you are nominating
Class / Primary
School Value – Respect
My friend shows respect by: (Tick √ if your
friend demonstrates the behavior) / J / JJ / JJJ
(a)  Being courteous to others
(b)  Greeting principal, teachers and friends
(c)  Following school rules
(d)  Valuing others
(e)  Listening while others speak
(f)  Appreciating differences such as ideas, race and religions
(g)  Treating others the way one wants to be treated
J = Seldom JJ = Sometimes JJJ = Always
School Value – Responsibility
My friend shows responsibility by: (Tick √ if
your friend demonstrates the behavior) / J / JJ / JJJ
(a) Being punctual and prompt in school tasks/activities
(b) Taking care of school equipment and using them
correctly
(c) Keeping school premises and classrooms clean and
tidy
(d) Accepting assigned tasks willingly
(e) Contributing to success of the team
(f) Taking ownership of own learning/actions
(g) Taking pride in own work
(h)  Accepting feedback from others
J = Seldom JJ = Sometimes JJJ = Always
School Value – Empathy
My friend shows empathy by: (Tick √ if your
friend demonstrates the behavior) / J / JJ / JJJ
(a) His/Her willingness to help others
(b) His/Her willingness to share with others
(c) Showing care and concern for others
(d) Being sensitive to others’ feelings and needs
(e) Seeking to understand
J = Seldom JJ = Sometimes JJJ = Always
School Value – Loyalty
My friend shows loyalty by: (Tick √ if your
friend demonstrates the behavior) / J / JJ / JJJ
(a) Having a sense of belonging to class and school
(b) Doing the best for class and school
(c) Singing the National Anthem and saying the Pledge
with pride
(d) Feeling proud of school and country
J = Seldom JJ = Sometimes JJJ = Always
School Value – Creativity
My friend shows creativity by: (Tick √ if your
friend demonstrates the behavior) / J / JJ / JJJ
(a) Being keen to learn
(b) Being adaptable
(c) Being willing to try new or difficult tasks
(d) Being able to accept failures and having the courage
to try again
(e) Being able to see things from different perspectives
(f) Being able to produce something purposeful and
original
J = Seldom JJ = Sometimes JJJ = Always
From the above, pick one/two of the school core values - Respect, Responsibility, Empathy, Loyalty and/or Creativity demonstrated by your friend and provide real-life examples of these behaviours. In other words, tell us why he/she deserves the award.
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Submitted by:

Name
Class

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A SELF- DIRECTED LEARNER, A GRACIOUS CITIZEN