EDUSAVE CHARACTER AWARD
NOMINATION FORM
(FOR UPPER PRIMARY PUPILS)
Part 1
Name of NomineeClass / Register No.
School Values (Respect, Integrity, Compassion, Humility, Endurance, Responsibility)
= Seldom / = Sometimes / = Always
Pupil shows the school values by:
(1) / RESPECT: We demonstrate kindness in words & deeds, treating others as we would like to be treated
My friend shows respect by:
(a) / being courteous and greets adults and peers / / /
(b) / listening attentively when someone is talking / / /
(c) / taking care of school property / / /
(d) / respecting others ideas and opinions / / /
Give example(s) of specific behaviour or incidents:
2 / INTEGRITY: We demonstrate moral courage and uprightness, being consistent in words and deeds.
Pupil shows integrity by:
(a) / informing a teacher when he sees any wrong-doing / / /
(b) / returning things that does not belong to him / / /
(c) / being honest and admits to mistakes / / /
(d) / acknowledging others for their ideas / / /
Give example(s) of specific behaviour or incidents:
3. / COMPASSION: We demonstrate love and care for others through words and deeds
Pupil shows compassion by:
(a) / being ready to help others / / /
(b) / showing care and concern for others / / /
(c) / participating actively in VIA programmes / / /
(d) / being willing to share / / /
Give example(s) of specific behaviour or incidents:
(4) / HUMILITY: We demonstrate the quality of being modest
Pupil shows humility by:
(a) / be receptive to feedback / / /
(b) / showing gratitude / / /
(c) / asking for help when required / / /
(d) / showing fairness in all dealings with peers / / /
Give example(s) of specific behaviour or incidents:
(5) / ENDURANCE: We demonstrate resilience in working towards goals and objectives
Pupil shows endurance by:
(a) / not giving up easily / / /
(b) / using personal strength effectively / / /
(c) / being not afraid to try out new ideas or approaches / / /
(d) / showing determination to overcome obstacles and difficulties / / /
Give example(s) of specific behaviour or incidents:
(6) / RESPONSIBILITY: We demonstrate the ability to behave sensibly in ways that are expected of us
Pupil shows responsibility by:
(a) / role-modelling good behaviour / / /
(b) / being able to complete tasks independently, promptly and on-time / / /
(c) / taking pride in his own appearance / / /
(d) / abiding by rules and instructions / / /
Give example(s) of specific behaviour or incidents:
Any other values displayed besides school values (e.g. harmony, loyalty, graciousness, civic-mindedness, etc. This list is not exhaustive.)
Name of Nominator
Class (for pupils only)
*Pupil / Staff / Pupil’s Parent / Others (Please specify):
*Delete where applicable
Part 2
(To be filled by Form Teacher)
Nationalilty / ☐Singapore Citizen☐Permanent Resident
☐Foreigner
Conduct Grade / Previous Year: ______
Current Year: ______
Conduct at CCA / Excellent / Very Good / Good*
VIA Hours / Project / ______hrs / Project:
Service Learning (if any) / Role: ______
Model Pupil Award / ☐Respect
☐Integrity
☐Compassion
☐Humility
☐Endurance
☐Responsibility
Name of Form Teacher / Signature / Date
*Delete accordingly
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