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Tan N Go Application Form

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Tan N Go Application Form Powered By Docstoc
					                            ASEAN Scholarship for Malaysia and Brunei 2009

I am applying for scholarships at

Choice of Test/Interview Centre


SECTION I : PERSONAL PARTICULARS
Full Name as in Official Document
   Surname (if applicable)
Gender
Date of Birth (DD/MM/YYYY)
Race
Religion
Country of Birth
Place of Birth
Citizenship
Birth Certificate Number
Identification Card Number
Passport Number
Date of Issue of Passport (DD/MM/YYYY)
Home Address
   Address Line 1
   Address Line 2
   Address Line 3
   City
   Postal Code
Home Telephone Number
Handphone Number
Fax Number
Email Address (Compulsory)
Email Address 2 (Optional)


SECTION II : EDUCATIONAL BACKGROUND
Name of Schools Attended
  Name of High School
     Type of School
     Language Medium
     Date Admitted (MMM-YY)
     Date Graduated (MMM-YY)
  Name of Secondary School
     Type of School
     Language Medium
     Date Admitted (MMM-YY)
     Date Graduated (MMM-YY)
  Name of Primary School
     Type of School
     Language Medium
     Date Admitted (MMM-YY)
     Date Graduated (MMM-YY)




                                               Page 1
                        ASEAN Scholarship for Malaysia and Brunei 2009

SECTION III : EXAMINATION RESULTS
                               2007 Final Examinations
  Level of Study
     Subject                                      Marks             Grade
   1 Malay Language
   2 English Language
   3 Chinese Language
   4 Mathematics
   5 Science
   6 Geography
   7 History
     Other Subjects                               Marks             Grade
   8
   9
  10
  11
  12
  13
  14
  15

                               2006 Final Examinations
  Level of Study
     Subject                                      Marks             Grade
   1 Malay Language
   2 English Language
   3 Chinese Language
   4 Mathematics
   5 Science
   6 Geography
   7 History
     Other Subjects                               Marks             Grade
   8
   9
  10
  11
  12
  13
  14
  15




                                             Page 2
                          ASEAN Scholarship for Malaysia and Brunei 2009

SECTION IV : FAMILY BACKGROUND
Father's Particulars
  Name
  Date of Birth (DD/MM/YYYY)
  Citizenship
  Country of Permanent Resident
  Occupation
  Employer / Company
Mother's Particulars
  Name
  Date of Birth (DD/MM/YYYY)
  Citizenship
  Country of Permanent Resident
  Occupation
  Employer / Company
Sibling Information
  Number of Brothers
  Number of Sisters
Sibling's Particulars (Eldest to Youngest)
  Sibling 1
      Name
      Relationship
      Date of Birth (DD/MM/YYYY)
      Citizenship
      Occupation
      Employer / Company / School
  Sibling 2
      Name
      Relationship
      Date of Birth (DD/MM/YYYY)
      Citizenship
      Occupation
      Employer / Company / School
  Sibling 3
      Name
      Relationship
      Date of Birth (DD/MM/YYYY)
      Citizenship
      Occupation
      Employer / Company / School


SECTION V : OUTSTANDING ACADEMIC ACHIEVEMENTS (for the last 2 years)
(Scholarships, awards, book prizes, etc)
                                Type of Award                                  Year (YYYY)




SECTION VI : CO-CURRICULAR ACTIVITIES IN SCHOOL (for the last 2 years)
(Sports, scout/guide/cadet groups, clubs, societies, prefect, monitor, etc)
       Name of Co-Curricular Activity                 Level of Participation   Position Held    Year
                                                                                               (YYYY)




                                                  Page 3
ASEAN Scholarship for Malaysia and Brunei 2009




                   Page 4
                             ASEAN Scholarship for Malaysia and Brunei 2009

SECTION VII : MEDICAL/OTHER BACKGROUND
1 Have you applied for any other scholarships to study in Singapore?
  If Yes, please give details below.
  Name of Scholarship                                  School (If Any)                Date of Application      Outcome



2 Have you ever been awarded a scholarship to study in Singapore and either rejected the
  award or had it terminated? If Yes, please give details below.
                                                                                                              Reason for
                                                                                        Year of Award         Rejection/
  Name of Scholarship                                     School (If Any)                  (YYYY)             Termination


3 Have you previously applied for the ASEAN Scholarships for Malaysia or Brunei?
  If Yes, Please specify year of application and level applied for below.


4 Have you ever suffered or are you currently suffering from any medical condition, illness,
  disease, mental illness or physical impairment? If Yes, Please give details below and indicate
  if you are currently seeking any treatment.


5 Have you ever been charged in a court of law in any country?
  If Yes, Please give details below.




SECTION VIII : SURVEY
(Please indicate "x" in the appropriate box)
 1 How did you come to know about the scholarship? (You may indicate more than one)
      Newspapers
      Friends
      Relatives
      School/ Teacher
      Internet
      Education Fairs
      Others (Pls specify)

2 From which newspaper did you or your contact read about the ASEAN scholarships?


3 How often do you access the internet?

4 Where do you access the internet? (You may indicate more than one)
    Home
    School
    Internet Café
    Others (Pls specify)

5 Have any of your siblings been awarded any scholarships to study in Singapore?
  If Yes, Please give details below.
                                                                                                              Reason for
                                                                                        Year of Award         Rejection/
  Name of Scholarship                                     School (If Any)                  (YYYY)             Termination




SECTION IX : DECLARATION BY APPLICANT AND PARENT / GUARDIAN
By submitting this form,
1 I declare that the particulars provided in this application are true and that I have not wilfully suppressed any
  material fact.

2 I declare that my parent / guardian as identified below is aware of my application for this scholarship.
      Parent / Guardian
      Name                                              Page 5
                            ASEAN Scholarship for Malaysia and Brunei 2009
      Identification Card Number

3 I understand that the Singapore Ministry of Education reserves the right to reject this application in the event
  that any information provided herein is found to be untrue and if such falsehoods are discovered after I have
  been awarded the scholarship, the award may be withdrawn.




                                                        Page 6

				
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