This form may take you 20 minutes to fill in.
Instructions
1. Please write clearly in BLOCK LETTERS. Complete all sections and indicate ‘NA’ for items not applicable.
2. Certified true copies of your birth and educational certificates, testimonials and other relevant documents must be produced when requested.
3. False particulars or intentional withholding of information will disqualify you, or if already awarded, terminate the scholarship.
4. SLA will not enter into correspondence with regard to reasons for non-selection of applicant.
Proposed Programme & Institution
(Please indicate the university and the course of study you are intending to pursue or currently pursuing)
Course of Study/ Institution ______
Starting/Current Year of Study ______
Choice of Public Agency
Undergraduate Scholarship (Local/Overseas)Please indicate your choice of the participating public agencies you wish to be considered for the Singapore Geospatial Scholarship. You must indicate a minimum of 2 choices; up to a maximum of 3 choices in your selection. Successful applicants will serve their bonds in 2 of the 3 participating agencies of his choice.
SLA NEA
Singapore Land Authority National Environment Agency
IDA URA
Infocomm Development Authority of Singapore Urban Redevelopment Authority
JTC PUB
Jurong Town Corporation Public Utilities Board (Overseas Scholarship Only)
Overseas Postgraduate (Masters) Scholarship
Please indicate your choice of the participating agencies you wish to be considered for the Singapore Geospatial Scholarship. You can indicate up to a maximum of 2 choices in your selection. Successful applicants will serve their bonds in one of the participating agencies of his choice.
SLA JTC
Singapore Land Authority Jurong Town Corporation
NEA
National Environment Agency
Personal Particulars
Full Name in BLOCK Letters ______
(underline surname, include aliases)
Name in Chinese Character ______
(if applicable)
Race ______Religion ______
Date of Birth ______Age ______Marital Status ______Gender: *Male / Female
*NRIC (Pink) / NRIC (Blue)/ Passport No. ______Citizenship No. (if any) ______
Country of Birth: *Singapore / Malaysia / Others ______
Present Citizenship: ______Previous Citizenship (if any) ______
Address ______
Tel No. (H) ______Tel No. (O) ______Tel No. (HP/Pg) ______
E-mail Address ______
Educational Details
Academic Qualifications
School / Institution / From / To / Highest Standard Passed* delete accordingly
Secondary School Academic Records
Year Taken / Year Taken
Subjects / Grade / Grade / Subjects / Grade / Grade
Year of Exam / Results
TOFEL
SAT I
No. of ‘O’ Level Passes / SAT II
Tertiary Academic Records
University Attended: / Country:Course of Study: / Merit: Yes/No* / Class of Hons: Year:
Subject / Grade / Subject / Grade
GPA for latest/final year * results:
Core-Curricular Activities
Sports / Uniformed Groups/ Society & Club Activities / Describe Your Participation / Period (month & year)From / To
Academic Scholarships & Awards
Employment History
Name of Employer / Duration / Basic Salary(Last Drawn) / Position Held / Job Scope
From / To
National Service Records
(If applicable, please submit a copy of your SAF Certificate of Service with your application)
Full-Time □ Part-Time □ Exempted □ ______
(if exempted, state reason)
Completed □ Yet-to-Serve □ Not Applicable □
Rank ______Vocation ______
Enlistment Date ______ORD ______
Name of Camp ______Camp Tel No. ______
Family Details
(Please provide the following information of all immediate family members, i.e., parents and siblings. If you are married, please provide your spouse and children’s.)
Name ______Relationship ______Age ____ Citizenship ______
Marital Status ______Occupation ______Current Salary per Month ______
Name of Employer / School ______
Name ______Relationship ______Age ____ Citizenship ______
Marital Status ______Occupation ______Current Salary per Month ______
Name of Employer / School ______
Name ______Relationship ______Age ____ Citizenship ______
Marital Status ______Occupation ______Current Salary per Month ______
Name of Employer / School ______
Family Details
Name ______Relationship ______Age ____ Citizenship ______
Marital Status ______Occupation ______Current Salary per Month ______
Name of Employer / School ______
General
Language Proficiency:
Spoken ______
Written ______
Hobbies & Interests -- Level of Proficiency (if applicable, e.g., Piano Grade V)
1. ______
2. ______
Character Referees
Name ______Occupation ______
Name of Organisation ______Contact No.______
Period Known ______Address ______
Name ______Occupation ______
Name of Organisation ______Contact No.______
Period Known ______Address ______
General Information
1. Have you ever suffered or are you suffering from medical condition, illness, disease, mental illness or Yes / No*
physical impairment?
2. (a) Do you have a criminal record 1 in Singapore? Yes / No*
(b) Have you ever been convicted in a court of law in any country (excluding parking offences or criminal Yes / No*
records disclosed above)?
3. Have you been charged with any offence in a court of law in Singapore or in any country for which the Yes / No*
outcome is pending (excluding parking offences)?
4. Are you aware of being under any current police investigations in Singapore or in any other country Yes / No*
following allegations made against you?
5. Have you been or are you under any financial embarrassment, ie, (a) an undischarged bankrupt, Yes / No*
(b) a judgement debtor, (c) have unsecured debts and liabilities of more than 3 months of last drawn pay,
(d) have signed a promissory note or an acknowledgement of indebtedness?
6. If your answer to any of the above questions is “Yes”, please give details.
______
______
7. Have you applied or are applying for any other scholarship? If yes, please give details. Yes / No*
a) Name of Scholarship ______Course ______
Organisation ______Outcome of Application ______
b) Name of Scholarship ______Course ______
Organisation ______Outcome of Application ______
8. From which source did you first learn of our scholarship?
Scholar’s Choice □ SLA Website □ School □ SLA Talks □ Friends □ Others □ ______
(please specify)
Declaration
I declare that the information given in this application form and any sheets attached is correct and accurate and I have not wilfully suppressed any material facts. I understand that submission of false particulars or wilful suppression of material facts will disqualify me or terminate the scholarship if I am so offered.
Signature of Applicant ______Date ______
1 By this, we refer only to a criminal record of a conviction under the Registration of Criminals Act
Singapore Geospatial Scholarship 271213