Oye Asfsgiaigiga

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NURSING / HEALTH SCIENCE SPONSORSHIP APPLICATION FORM
Mail To:

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a. b. c. ● ● ● ●

IMPORTANT APPLICATION NOTES
Please read the following instructions carefully. This application must be accompanied by copies of the documents listed in (c) below. The originals should NOT be forwarded but must be produced later. All information required must be supplied. If not applicable, write N.A. False particulars or wilful suppression of material facts will render you liable to disqualification. Please complete and submit the application form together with the following: One passport-sized photo Educational certificates Academic transcripts (for current students) ● Copy of NRIC / Passport ● Co Curricular Activities (CCA) records ● Educational institution medical report (if applicable)

Jurong Health Services Alexandra Hospital 378 Alexandra Road, Singapore 159964 Attention : Human Resource Scholarship & Sponsorship Unit

Letter of Acceptance from the relevant educational institution (if applicable)

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AWARD APPLYING FOR
Please indicate with (X) the award you are applying for. NURSING Sponsorship / Scholarship for Bachelor of Science (Nursing) Sponsorship for Diploma in Nursing Sponsorship for NITEC in Nursing HEALTH SCIENCE Scholarship for Degree in Health Science (indicate field of study) Health Science Sponsorship for Diploma in Diagnostic Radiography Health Science Sponsorship for Diploma in Physiotherapy Health Science Sponsorship for Diploma in Occupational Therapy Name of Institute: Field of Study: (please fill in if the field of study is not indicated on the left column) Year of study (as at application): Year of study (as at application): Course Commencement Date : Course Commencement Date : Name of Institute:

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PERSONAL PARTICULARS
*Please delete where appropriate. Full Name (Please underline family name) Name in Chinese Character (if any)

NRIC / Passport No:

*Colour of Singapore IC : Pink / Blue / Not Applicable

*Gender

Male / Female

Address in Singapore

Overseas Address (compulsory for foreigners)

Date of Birth (dd/mm/yyyy)

Country of Birth

Age

Race

Marital Status

Nationality

Religion

Dialect Group

Email Address

Contact No Home Handphone

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IMMEDIATE FAMILY MEMBERS PARTICULARS
Full Name Relationship Occupation Employer

Father

Mother

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NATIONAL SERVICE (if applicable)
For those who have completed National Service, a copy of the Certifcate of Conduct should be attached. Enlistment Date (dd/mm/yyyy) Operational Ready Date (dd/mm/yyyy) Distruption Period (if any)

If exempted, please state reason

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i.

EDUCATION
Name of Exam: Period of Study (From) Period of Study (To)

Name of Institution

Stream of Study

Subject

Grade

Subject

Grade

ii

Name of Exam:

Period of Study (From)

Period of Study (To)

Name of Institution

Stream of Study

Subject

Grade

Subject

Grade

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CO-CURRICULAR ACTIVITIES
Please fill in your CCA records from Secondary to Pre-University levels in chronological order. Please attach records separately if space is insufficient. Institution CCA Activities Position Description of involvement Year of Event

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i. ii.

LANGUAGE PROFICIENCY
Please indicate Good (G), Fair (F) or Poor (P). English Spoken Written Chinese Tamil Others

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a.

OTHER INFORMATION
* Please delete where applicable. Have you previously applied for any sponsorship with JurongHealth? If yes, please provide details Have you applied for other scholarships/bursaries/awards? If yes, please provide details Are you currently a recipient of other scholarships/bursaries/awards? If yes, please provide details Have you been or are suffering from any disease/illness/major medical condition or physical impairment? If yes, please provide details Have you been convicted in a court of law in any country? If yes, please provide details *Yes / No *Yes / No *Yes / No *Yes...
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