SCHOLARSHIPS FOR UNDERGRADUATE STUDIES IN SINGAPORE
Application Form Completion Instructions申請表格填寫(xiě)指示
1. Application Form must be completed clearly by the applicant personally.
表格必須由申請人親自填寫(xiě)、字跡必須清楚。
2. All fields must be filled in and fields that are not applicable should be indicated as “N.A.”
表格中每欄都需填寫(xiě)，不適用部分請填上“N.A.” 。
3. Section I (Declaration by Applicant and Parent / Guardian) must be signed by the applicant and one of his/her parents.
申請人及其一位家長(cháng)需在《申請人與家長(cháng)/監護人聲明》上簽字。
4. Please attach your recent photograph and an A4-size photocopy of each of the following documents: 請將表格填妥并附上兩寸近照一張，及以下文件A4影印本各一份:
· Identity Card and Residential Registration Document 身分證 以及 戶(hù)口本
· Senior Middle School Report 高中學(xué)年報告, 含學(xué)習成績(jì)單及操行評語(yǔ)
· Senior Middle Entrance Examination Results 初中畢業(yè)會(huì )考成績(jì)單
· SM2 Mid-Year Examination Results 高二年中期末考試成績(jì)單
· Award Certificates (if any) (e.g. National Mathematics Olympiad) 獎狀（若有） （例如：全國數學(xué)奧賽省一等獎等）
5. Incomplete Application Forms will be rejected. 未經(jīng)填妥的表格將被退回。
6. Please print the application on duplex prior to completion and submission. 請將表格雙面 打印在A(yíng)4白紙后再填寫(xiě)。
7. Please note that any false entry in the application will be rejected and will lead to the termination of scholarship award (if offered). 所提供的資料如果有誤，申請將作廢，獎學(xué)金將被撤銷(xiāo)（如果已獲頒）。
SM2/16
Scholarships forUndergraduate Studies in Singapore
2012新加坡企業(yè)獎學(xué)金
Application Form申請表格
Please complete thisform withthe photograph andattach a photocopy of the following documents:
請將表格填妥，并附上下列文件影印本各一份:
· IdentityCard and Residential Registration Document 身分證 以及 戶(hù)口本
· SeniorMiddle School Report 高中學(xué)年報告, 含學(xué)習成績(jì)單及操行評語(yǔ)
· SeniorMiddle EntranceExamination Results 初中畢業(yè)會(huì )考成績(jì)單
· SM2 Mid-Year ExaminationResults高二年中期末考試成績(jì)單
· AwardCertificates(if any)(e.g. National Mathematics Olympiad) 獎狀（若有）（例如：全國數學(xué)奧賽省一等獎等）
(A) Personal Particulars 申請人資料
Name in Hanyu Pinyin (in BLOCK letters, underline surname)
漢語(yǔ)拼音姓名（用正楷書(shū)寫(xiě)，在姓氏底部劃線(xiàn)）
Name in Chinese 中文姓名
Gender 性別*
Male男
Female 女
Date of Birth 出生日期
Province of Birth
出生地 (省)
City of Birth
出生地 (市)
Race 民族
Religion 宗教*
None 無(wú)
_________
日日
月月
年年年年
1
9
Nationality國籍 *
China中國
F ________
Identity Card Number 身份證號碼
Passport Number 護照號碼
Email電子郵件
Have you previously applied for Permanent Residence (PR) in Singapore? 是否曾申請新加坡永久居留權？
Yes 是 If yes, please indicate your PR effective date (DD-MM-YYYY) :
如是，請注明永久居民權的有效期（日/月/年）: _________日_________月____________年
No 否
Have you ever studied in Singapore before? 是否曾在新加坡學(xué)習？
Yes是
No 否
If yes, please indicate 如是，請注明：
Name of school 學(xué)校名稱(chēng):__________________________________________________________________________________
Period of studies (YYYY to YYYY) 在校時(shí)間: 從____________年至________________年
Home Address 住址 (請用中文填寫(xiě))
Postal Code 郵編:
Home Number 住家電話(huà)號碼
001－86－ ?。?div style="height:15px;">
區號 電話(huà)
Handphone No. 手機號碼
其他電話(huà)號碼: _____________________
(B) School Attended 學(xué)習經(jīng)歷（請用中文填寫(xiě)）
Name of schools attended including the present school (in chronological order).
Please state the province and city that the school is located.請用中文填寫(xiě)所就讀過(guò)的學(xué)校（請按年序填寫(xiě)）
Primary School
小學(xué)
省
市
地址
Junior Middle School
初中
地址
Senior Middle School
高中
省
市
地址
*Please tick where appropriate. 請在正確的格子內標上?
(C) Examination Results：Class & Level Details班級與學(xué)年考試成績(jì)資料
Please give your scores (against full scores) for the subjects taken at the Senior Middle Entrance Examination Results, SM1 Year-End Examination and SM2 Mid-Year Examination. Please also fill in your ranking in class and level.
請在下列欄項填上初中畢業(yè)會(huì )考成績(jì) [括號內請列滿(mǎn)分, 如‘135 /150’],高一期末，高二期中考試成績(jì)，以及你在班級與年級的排名。
Subject
科目
Senior Middle Entrance Examination Results
初中畢業(yè)會(huì )考成績(jì)
SM1 Year-End Examination
高一期末考試成績(jì)
SM2 Mid-Year Examination
高二年中期末考試成績(jì)
得分
滿(mǎn)分
得分
滿(mǎn)分
得分
滿(mǎn)分
Politics 政治
Chinese Language 中文
Mathematics 數學(xué)
Physics 物理
Chemistry 化學(xué)
Biology 生物
English Language 英語(yǔ)
History 歷史
Geography 地理
Others 其他
Total Marks
總分
Class Ranking
班級排名
Class Rank
班級名次 Class Size
班級名額
Level Ranking
全級排名
Level Rank
年級名次 Level Size
學(xué)年名額
Living in Boarding School 現在是否居住在宿舍 *
Yes 是
No 否
Class Type
班類(lèi)*
Science
理科
Experimental
實(shí)驗
Arts
文科
Olympics
奧林匹克
Key point
重點(diǎn)
Hong Zhi
宏志
(D) Academic Achievements (eg 2011 National Mathematics Olympiad, 2nd in Province)
特出學(xué)術(shù)表現 ( 例如 : 2011年全國數學(xué)奧林匹克賽，省二等獎)
(E) Other Achievements 課外活動(dòng)表現 ( 例如 : 校際籃球比賽冠軍)
*Please tick where appropriate. 請在正確的格子內標上?
(F) Particulars of Family Members申請人家屬資料
Please attach a separate sheet if there are more family members. 若家中還有更多成員, 請另附紙頁(yè)書(shū)寫(xiě)。
Name of Father / Guardian in Hanyu Pinyin (in BLOCK letters, underline surname)
父親/監護人漢語(yǔ)拼音姓名（用正楷書(shū)寫(xiě)，在姓氏底部劃線(xiàn)）
Name in Chinese
中文姓名
Date of Birth 出生日期
Nationality國籍 *
China中國
_____________
Race 民族
Are you also a Permanent Resident of another country? 是否擁有其他國家永久居留權？
Yes是 If yes, please state country
如是，請注明國家 ___________________
No 否
日日
月月
年年年年
Province of Birth 出生地 (省)
Identity Card Number 身份證號碼/ 戶(hù)口登記號碼
Passport Number 護照號碼
Handphone No 手機號碼/ 聯(lián)絡(luò )號碼
Email address 電子郵箱
Name of Employer/ Company單位名稱(chēng)
Designation/ Position 職銜
Occupation Field/ Sector 職業(yè)領(lǐng)域
Administrative/ Clerical 行政/文秘
Building/ Construction 建筑/土木
Civil Service 政府機關(guān)
Education/ Training 教育、培訓
Others (please specify)
其他 ，請注明
Engineering 工程
Accounting/ Finance/ Investment
會(huì )計、金融、投資
Corporate Support (Eg HR, Marketing)
企業(yè)經(jīng)營(yíng)（人力資源、市場(chǎng)營(yíng)銷(xiāo)等)
IT/ Programming 信息技術(shù)、程序編程
Legal 法律
Healthcare/ Medical 保健、醫療護理
Service Related
(Hospitality/ Tourism/ Food & Beverage)
服務(wù)類(lèi)(酒店、旅游、餐飲)
Science/ Other R&D Related 科研
Highest Qualifications Attained 最高學(xué)歷
Post Graduate Degree 研究生學(xué)位
Diploma 理工學(xué)院
Primary 小學(xué)
Degree 大學(xué)
Secondary/High School 初中/高中
No Formal Schooling 無(wú)正規教育
Others (please specify) 其他 ，請注明
_______________________
Name Mother in Hanyu Pinyin (in BLOCK letters, underline surname)
母親漢語(yǔ)拼音姓名（用正楷書(shū)寫(xiě)，在姓氏底部劃線(xiàn)）
Name in Chinese
中文姓名
Date of Birth 出生日期
Nationality國籍 *
China中國
_____________
Race 民族
Are you also a Permanent Resident of another country? 是否擁有其他國家永久居留權？
Yes是 If yes, please state country
如是，請注明國家 ___________________
No 否
日日
月月
年年年年
Province of Birth 出生地 (省)
Identity Card Number 身份證號碼/ 戶(hù)口登記號碼
Passport Number 護照號碼
Handphone No 手機號碼/ 聯(lián)絡(luò )號碼
Email address 電子郵箱
Name of Employer/ Company單位名稱(chēng)
Designation/ Position 職銜
Occupation Field/ Sector 職業(yè)領(lǐng)域
Administrative/ Clerical 行政/文秘
Building/ Construction 建筑/土木
Civil Service 政府機關(guān)
Education/ Training 教育、培訓
Others (please specify)
其他 ，請注明
Engineering 工程
Accounting/ Finance/ Investment
會(huì )計、金融、投資
Corporate Support (Eg HR, Marketing)
企業(yè)經(jīng)營(yíng)（人力資源、市場(chǎng)營(yíng)銷(xiāo)等)
IT/ Programming 信息技術(shù)、程序編程
Legal 法律
Healthcare/ Medical 保健、醫療護理
Service Related
(Hospitality/ Tourism/ Food & Beverage)
服務(wù)類(lèi)(酒店、旅游、餐飲)
Science/ Other R&D Related 科研
Highest Qualifications Attained 最高學(xué)歷
Post Graduate Degree 研究生學(xué)位
Diploma 理工學(xué)院
Primary 小學(xué)
Degree 大學(xué)
Secondary/High School 初中/高中
No Formal Schooling 無(wú)正規教育
Others (please specify) 其他 ，請注明
_______________________
*Please tick where appropriate. 請在正確的格子內標上?
Name of Sibling 1 in Hanyu Pinyin (in BLOCK letters, underline surname)
兄弟或姐妹1, 漢語(yǔ)拼音姓名（用正楷書(shū)寫(xiě)，在姓氏底部劃線(xiàn)）
Name in Chinese 中文姓名
Gender 性別*
Male男
Female 女
Date of Birth 出生日期
Nationality國籍 *
China中國
_____________
Race 民族
Are you also a Permanent Resident of another country? 是否擁有其他國家永久居留權？
Yes是 If yes, please state country
如是，請注明國家 ___________________
No 否
日日
月月
年年年年
Province of Birth 出生地 (省)
Identity Card Number 身份證號碼/ 戶(hù)口登記號碼
Passport Number 護照號碼
Handphone No 手機號碼/ 聯(lián)絡(luò )號碼
Email address 電子郵箱
Name of Employer/ Company/ School 單位名稱(chēng), 若仍求學(xué), 請注明學(xué)校
Designation/ Position 職銜
Occupation Field/ Sector 職業(yè)領(lǐng)域
Administrative/ Clerical 行政/文秘
Building/ Construction 建筑/土木
Civil Service 政府機關(guān)
Education/ Training 教育、培訓
Others (please specify)
其他 ，請注明
Engineering 工程
Accounting/ Finance/ Investment
會(huì )計、金融、投資
Corporate Support (Eg HR, Marketing)
企業(yè)經(jīng)營(yíng)（人力資源、市場(chǎng)營(yíng)銷(xiāo)等)
IT/ Programming 信息技術(shù)、程序編程
Legal 法律
Healthcare/ Medical 保健、醫療護理
Service Related
(Hospitality/ Tourism/ Food & Beverage)
服務(wù)類(lèi)(酒店、旅游、餐飲)
Science/ Other R&D Related 科研
Highest Qualifications Attained 最高學(xué)歷
Post Graduate Degree 研究生學(xué)位
Diploma 理工學(xué)院
Primary 小學(xué)
Degree 大學(xué)
Secondary/High School 初中/高中
No Formal Schooling 無(wú)正規教育
Others (please specify) 其他 ，請注明
_______________________
Name of Sibling 2 in Hanyu Pinyin (in BLOCK letters, underline surname)
兄弟或姐妹2, 漢語(yǔ)拼音姓名（用正楷書(shū)寫(xiě)，在姓氏底部劃線(xiàn)）
Name in Chinese 中文姓名
Gender 性別*
Male男
Female 女
Date of Birth 出生日期
Nationality國籍 *
China中國
_____________
Race 民族
Are you also a Permanent Resident of another country? 是否擁有其他國家永久居留權？
Yes是 If yes, please state country
如是，請注明國家 ___________________
No 否
日日
月月
年年年年
Province of Birth 出生地 (省)
Identity Card Number 身份證號碼/ 戶(hù)口登記號碼
Passport Number 護照號碼
Handphone No 手機號碼/ 聯(lián)絡(luò )號碼
Email address 電子郵箱
Name of Employer/ Company/ School 單位名稱(chēng), 若仍求學(xué), 請注明學(xué)校
Designation/ Position 職銜
Occupation Field/ Sector 職業(yè)領(lǐng)域
Administrative/ Clerical 行政/文秘
Building/ Construction 建筑/土木
Civil Service 政府機關(guān)
Education/ Training 教育、培訓
Others (please specify)
其他 ，請注明
Engineering 工程
Accounting/ Finance/ Investment
會(huì )計、金融、投資
Corporate Support (Eg HR, Marketing)
企業(yè)經(jīng)營(yíng)（人力資源、市場(chǎng)營(yíng)銷(xiāo)等)
IT/ Programming 信息技術(shù)、程序編程
Legal 法律
Healthcare/ Medical 保健、醫療護理
Service Related
(Hospitality/ Tourism/ Food & Beverage)
服務(wù)類(lèi)(酒店、旅游、餐飲)
Science/ Other R&D Related 科研
Highest Qualifications Attained 最高學(xué)歷
Post Graduate Degree 研究生學(xué)位
Diploma 理工學(xué)院
Primary 小學(xué)
Degree 大學(xué)
Secondary/High School 初中/高中
No Formal Schooling 無(wú)正規教育
Others (please specify) 其他 ，請注明
_______________________
*Please tick where appropriate. 請在正確的格子內標上?
(G) Other relevant information其他相關(guān)資料
Please tick the appropriate box 請在正確的格子內標上?
1. 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.
身體或心理健康是否出現過(guò)問(wèn)題？如是，請說(shuō)明。
Yes是 _______________________________________________________________________________
No 否
2. Have you ever been charged in a court of law in any country? If yes, please give details below.
是否曾在任何國家被控上法庭？如是，請說(shuō)明。
Yes是 _______________________________________________________________________________
No 否
3. Have you previously applied for other scholarships to study in Singapore? If yes, please give details below.
是否曾申請過(guò)赴新加坡留學(xué)的獎學(xué)金？如是，請說(shuō)明。
Yes是 _______________________________________________________________________________
No 否
4. Have you ever been awarded a scholarship / award to study in Singapore and either rejected the award or had it terminated? If yes, please give details below.
是否曾獲頒任何到新加坡留學(xué)的獎學(xué)金，但拒絕接受或終止該獎學(xué)金? 如是,請提供理由。
Yes是 _______________________________________________________________________________
No 否
5. Have any of your relatives been awarded scholarships to study in Singapore? If yes, please give details below.
是否有任何親屬曾獲頒獎學(xué)金到新加坡留學(xué)？如是，請說(shuō)明。
Yes是 _______________________________________________________________________________
No 否
Name of Relative
親屬姓名
Relationship關(guān)系
Name of Award
獎學(xué)金名稱(chēng)
Country of Award
頒獎國家
Period Held期間
(從xx年至xx年)
(H) ANTECEDENT OF APPLICANT 申請人背景
Please tick (√) where appropriate 請在適用處打勾(√)
(a) Have you ever been refused entry into or deported from any country, including Singapore?
您是否曾被任何國家(包括新加坡)拒絕入境或遣返回國?
□ Yes是 □No否
If the answer is “Yes”, please furnish details.
若以上答案為 “是”,請提供詳情。
______________________________________________________________________________
______________________________________________________________________________
(b) Have you ever been convicted in a court of law in any country, including Singapore?
您是否曾在任何國家 (包括新加坡) 的法律下被宣判有罪?
□ Yes是 □No否
If the answer is “Yes”, please furnish details.
若以上答案為 “是”,請提供詳情。
____________________________________________________________________________________________________________________________________________________________
(c) Have you ever been prohibited from entering Singapore?
您是否曾被禁止進(jìn)入新加坡?
□ Yes是 □No否
If the answer is “Yes”, please furnish details.
若以上答案為 “是”,請提供詳情。
____________________________________________________________________________________________________________________________________________________________
(d) Have you ever entered Singapore using a different passport or name?
您是否曾用其他名字或護照進(jìn)入新加坡?
□ Yes是 □No否
If the answer is “Yes”, please furnish details.
若以上答案為 “是”,請提供詳情。
____________________________________________________________________________________________________________________________________________________________
(e) Did you reside in other countries, other than your country of origin, for one year or more during the last 5 years?
您是否在過(guò)去五年內, 除了在您所屬?lài)彝?，在其他國家居留一年或以上?div style="height:15px;">
If the answer is “Yes”, please furnish details.
1. I declare that the particulars provided in this application are true and that I have not wilfully suppressed any material fact. 我確定以上提供的資料全屬真實(shí)，沒(méi)有任何隱瞞。
3. Certified copies of the relevant documents required are attached. 已附上相關(guān)的文件副本。
______________________ _______________________________
Date 日期 Signature of Applicant申請人簽名
I, *father/ mother/ guardian of the applicant, have no objection to my *son/ daughter/ ward’s application for the scholarships to pursue his / her studies in Singapore.
______________________ ___________________________________ ______________________________
Date日期 Name of *Father/Mother/Guardian Signature of *Father/Mother/Guardian
Write a self introduction or a short essay on a subject of personal importance to you (in less than 500 words). You may choose any topic. Examples include: an event which has influenced you; talk about your ambition or a family member/friend/person who had a significant influence on you. Please note that the essay is an important part of your Scholarship application.
寫(xiě)一篇不超過(guò)500字的文章介紹自己、或談述一個(gè)和你有切身關(guān)聯(lián)的內容。例如: 一段影響你的經(jīng)歷、或講述你的志愿；抑或介紹一名對你產(chǎn)生重要影響的親人、朋友或人物。注意：這篇文章是獎學(xué)金申請的重要環(huán)節。
