ILTC-UPGRADING ORGANISATION RECOMMENDATION FORM

(TO BE COMPLETED BY SUPPORTING INSTITUTION)

Please follow the following application process:

  1. Complete ALL fields in the Application Form.
  2. This form should take about 15 mins to complete.

  1. Email the completed Recommendation Form to ILTC-UP Secretariat (.).

  1. For any enquiries, please contact ILTC-UP Secretariat at 6632 1144 or 6603 6868 or .

IMPORTANT:
  • Please ensure that ALL sections of the recommendation form are completed before submission of application. AIC reserves the right to reject any incomplete form.
  • The information provided in this form will be used by AIC for the purpose of processing your application. By submitting this application, you voluntarily provide your personal data to AIC and consent to our use and disclosure of your personal data for such purposes.

APPLICANT INFORMATION
Name of Organisation
Name of Staff who is supported
(please underline surname)
Degree Title
Training Institution / Country
Duration of course
(Number of Months)
BENEFITS TO ORGANISATION
  1. How will your staff benefit from his/her participation in the degree programme?
(E.g. career development, leadership abilities, skills application, care for more complex patients)
  1. How do you expect the staff to better contribute to your organisation after obtaining the degree?

  1. What is the expected career path for the staff after he/she completes the degree programme?

  1. Does the staff have the potential to assume a leadership role in the organisation upon completion of the degree programme?

  1. How does the organisation intend to help the staff to manage both work and study at the same time if he/she continues to work during his/her study period?

PROJECTED BUDGET
Tuition Fees / $
Compulsory Fees
(E.g. Application Fee, Registration Fee, Medical Checkup) / $
Overseas Immersion Programme
(For SIT courses) / Air Ticket (return) / $
Airport Transfer / $
Travel Insurance / $
Visa / $
Accommodation / $
Subsistence Allowance will be calculated by Secretariat
Is Locum Required / Select
(If yes, Locum costwill be calculated by Secretariat)
Any other costs
Has the staff applied for any other funding other than ILTC-UP for this application? / Select
If Yes, please state:
STAFF APPRAISAL
Appraisal rating for Applicant
(based on last appraisal) / Select
Date of last appraisal
(DD/MM/YYYY)
ENDORSEMENT BY HEAD OF DEPARTMENT
Application is supported / Select /
If not supported, please state reason:
Name
Designation
Signature / Date
ENDORSEMENT BY CHIEF EXECUTIVE OFFICER OR EQUIVALENT
Application is supported / Select /
If not supported, please state reason:
I understand and agree that the organisation will be co-funding 10% of the course fees and other compulsory fees necessary for completion of the degree programme.
Name
Designation
Signature / Date

The information provided in this application will be used by AIC for the purpose of processing your application. By submitting this application, you voluntarily provide your personal data to AIC and consent to our use and disclosure of your personal data for such purposes.

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ILTC-UP Recommendation Form_v1.0 (Aug 15)