BURSARY APPLICATION FORM 2011
*Pls delete accordingly
STUDENT'S PERSONAL PARTICULARS
Name: NRIC :
Sex : M / F * Date of Birth : Citizenship : Singapore / PR *
Home Address :
Postal Code :
Contact No. (Home): E-mail Address :
(Hp):
Type of Accomodation : 1-rm / 2-rm / 3-rm / 4-rm / 5-rm / Others (pls specify) * : ____________________________
Ownership : Purchased / Rental *
EDUCATION RELATED INFORMATION
Name of ITE / JC / Polytechnic / University :
Year/Level :
Course & qualification upon completion:
Commencement Date of Course :
Expected Date of Graduation:
FAMILY PARTICULARS
(I) Details of all family members including dependants living in the same household must be included.
(II) A copy of the latest payslip or Income Tax Assessment Returns or letter from employer must be submitted for all employed
family members
Contributing
Marital to SINDA ? Gross Monthly
Name Relationship Age Status Citizenship Contact No Occupation (Yes/No) Income ($)
Father
Mother
TOTAL $
Total number of members living in the home (including the applicant) _________________
Highest Educational Level of Head of Household : No Formal Education / Primary / Secondary / Post Secondary *
OTHER SOURCES OF FINANCIAL ASSISTANCE
Are you currently receiving any assistance from :
siblings / relatives not living in the same household
Ministry of Education
any other organisations e.g. CCs, CDCs, hospitals, welfare organizations, Family Service Centres
If yes, please provide details
Person/Organization Providing Assistance Period of Assistance Amount
TOTAL
TO BE COMPLETED BY PARENT / GUARDIAN*
I declare, to the best of my knowledge and belief, that the above particulars are true and correct and that I would
inform SIET if there is any change in my financial status. I hereby authorise the Ministry of Education, my child's/ward's
school and other relevant organisation to release information to SIET for the purpose of monitoring and evaluating my
child's/ward's performance
Name of Parent/Guardian* Signature Date
*Please delete accordingly