22-Feb-16

CONFIDENTIAL

SIM GLOBAL EDUCATION

SCHOLARSHIP

Please attach a
photograph of
yourself taken within
the last 1 year

Closing Date: 31 March 2016,

12.00 pm sharp
To:

Box 15: SIM Global Education Bursary & Scholarship Box

SIM HQ, Block A, Level 2
461 Clementi Road
Singapore 599491

PLEASE READ THESE INSTRUCTIONS CAREFULLY.

1.
2.
3.

This form is to be completed and submitted on or before the closing date specified, together with supporting documents.
Do not leave any item blank. If it is not applicable to you, indicate N.A.
False particulars or wilful suppression of material facts will render you liable to disqualification, or, if awarded, to
revocation of scholarship and/or appropriate legal proceedings.
SIM does not enter into correspondence with regard to the reasons for non-selection of candidates.
The Scholarship is open to Bachelors Degree Programmes in SIM GE only.
All late submissions will not be considered.

4.
5.
6.

1.

SCHOLARSHIP APPLIED FOR

(Please tick the one of the following)
Partner University of SIM GE:

For New Students:

Academic Excellence and Leadership
Sports and Artistic Talent

Name of Programme of Study:

(indicate full-time or part-time)

For Existing Students:

Academic Excellence and Leadership

Programme Duration:
From: ____________ To: ______________

Sports and Artistic Talent

2.

PERSONAL PARTICULARS

Full Name (In block letters, underline surname and alias if any):
Dr/Mr/Miss/Mrs/Mdm*
Nationality:

Race/Ethnic Group

NRIC (Singaporean/Singapore PR) /

FIN No. (SIM GE international student) /
Passport No. (All international applicants) :

Marital Status: Single / Married/ Divorced / Widowed *

Date of Birth (dd/mm/yy):

Age:

Home Address:

Address for Correspondence (if different from above):

Home Tel (Local):

Home Tel (Overseas):

Mobile No:

Office Tel:

E-mail Address / SIM Mymail:

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22-Feb-16
3.

FAMILY BACKGROUND
Please include the particulars of your immediate family members and if you are married, the particulars of your
spouse and children.
Name

4.

Age

Occupation, Name of
Employer/School

Relationship to Applicant

Citizenship

Marital
Status

NATIONAL SERVICE (where applicable)

Please indicate your liability and complete one of the following sections: (1), (2) or (3)

Liability FULL-TIME/EXEMPTED/YET-TO-SERVE/NOT-APPLICABLE*

(1) Full Time

Enlistment Date

Operation Ready Date

Vocation

Highest Rank Attained

Unit Attached To

(2) Exempted

Reasons for Exemption

Date Registered

(3) Yet-To-Serve

Date Registered

Enlistment Date (if known)

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22-Feb-16

5.

EDUCATIONAL QUALIFICATIONS

Please provide all details of education (i.e. Junior College, High School, Polytechnic, University or Institute) that you have
completed or are currently pursuing. Certified copies (in original language with English translation, if applicable) of all
certificates, transcripts or reports showing grades awarded must be attached.
Year
Qualification
Awarding Institution, Country
Results
Obtained
Best 5 including English
GCE O Levels

English Grade

GCE A Levels

H2 Grades

Diploma(Polytechnic),
Name of Diploma

Cumulative Graduating
GPA

Others

Please complete information if you sat for the following National Examination.
Country
Cambodia
China

Name of National Examination

Examination Year

Results

High School Examination

NCEE (Gao Kao)

Year 10 __________________________________
India

Year 12 __________________________________
(Please state Board of Examination)

Indonesia

National Final Evaluation Examination

(SMA or SMU EBTANAS)

Sijil Pelajaran Malaysia (SPM)

Malaysia

Unified Examination Certificate (UEC)

Sijil Tinggi Persekolahan Malaysia (STPM)

Mymmar

Basic Education High School (BEHS)

Vietnam

High School (Hoc Ba)

Others

6.

OTHER QUALIFICATIONS/SPECIAL COURSES

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22-Feb-16
7.

SCHOLARSHIP/PRIZES/AWARDS
Please provide documentary evidence of all awards
Year

8.

Type of Award (For scholarships, please indicate the type, duration, value & bond if any)

CO-CURRICULAR ACTIVITIES (CCA) Eg. Sports, Arts, Student Clubs etc

Please submit copies of documentary evidence

Period of
involvement
Type of Activities
From
To

9.

Level of Participation and position held

EMPLOYMENT HISTORY (if applicable, including part-time jobs)

Years of Working Experience : (
) years
Name of Employer

Position Held

From

To

Nature of job/duties

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22-Feb-16

In a separate attachment, answer ALL the following questions. This must be submitted together with your
application.
10. Discuss experiences or influences in your personal life that have defined who you are today. (500 word limit).
11. What have been your most significant leadership experiences? What challenges did you face, and what impact did the
experiences have on you? (500 word limit)
12. Describe why you wish to obtain a university education and why you are deserving of a scholarship. (500 word limit)
13. Please share how you wish to contribute to SIM Global Education and its student population. (500 word limit)

14. Answer the following questions by deleting Yes or No in the boxes provided. If Yes give details in the
right hand margin.
1. Have you ever been charged with any offence or convicted by
any Court or detained by the authorities under the provisions of
any law in any country? (Important: Please note you must give
full details of any charges made against you even if you were
eventually acquitted by the Court).
2. Has any bankruptcy action ever been taken against you?

Yes/No

Yes/No

3. Has any Court judgement or order ever been made against you
ordering you to pay a debt to someone?

Yes/No

4. Have you signed a promissory note or an acknowledgement of

indebtedness for which the amount pledged has not already been
fully repaid?
5. Have you ever been employed in any capacity with SIM, its
predecessors or its subsidiaries? Give designation, period of
employment and reason for leaving.
6. Have you applied on any previous occasions for scholarships or
employment in any capacity with SIM? Give date and position
applied for.
7. Have you any relative in SIM? If yes, please give designation,
name and relationship.
8. Have you suffered from any mental illness or any physical
illness or disability for which you have received medical
treatment? (e.g. diabetes, tuberculosis, epilepsy, etc)

Yes/No

Yes/No

Yes/No

Yes/No
Yes/No

15. ANY OTHER RELEVANT INFORMATION

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22-Feb-16

16. CONFIDENTIALITY CLAUSE

By submitting this application, you consent to our collection and use of your personal data (as defined in the Personal Data
Protection Act 2012, PDPA), including its disclosure to relevant parties where necessary, for the purpose of processing
your application. We are committed to maintaining the confidentiality of your personal information and undertake not to
divulge to any third party without your prior written consent SUBJECT TO our obligation to disclose to any Singapore
government authority in compliance with the law and/or to the organisation conferring/awarding the qualification.

17. DECLARATION
I declare that the information given by me in this scholarship application is true to the best of my knowledge and I have not
withheld any relevant particulars. I have disclosed all the information required to be given in this application. I accept that if
any of the information given by me in this scholarship application is in any way false, or incorrect, the Company shall have
the right to revoke the scholarship, if awarded, and take appropriate legal action without notice and without assigning any
reason.

Signature:

Date:

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22-Feb-16

Scholarship Application Checklist

Please submit the following documents:
The SIM Global Education Scholarship Application Form (with passport
sized photo taken within the last 1 year)
Certified copies (in original language with English translation, if
applicable) of all certificates, transcripts and reports showing grades
awarded by institutions that you have completed or are currently pursuing.

O Level
A Level/ High School Certificate/ Diploma
Cumulative results of your current programme in SIM GE
Bachelors Degree (if applicable)
Documentary evidence of all co-curricular activities/ scholarships/
awards
Photocopy of passport OR NRIC
National Service Testimonial (if applicable)

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