SCHOLARSHIPS FOR UNDERGRADUATE STUDIES IN SINGAPORE
Application Form Completion Instructions申请表格填写指示
1. Application Form must be completed clearly by the applicant personally.
表格必须由申请人亲自填写、字迹必须清楚。
2. All fields must be filled in and fields that are not applicable should be indicated as “N.A.”
表格中每栏都需填写，不适用部分请填上“N.A.” 。
3. Section I (Declaration by Applicant and Parent / Guardian) must be signed by the applicant and one of his/her parents.
申请人及其一位家长需在《申请人与家长/监护人声明》上签字。
4. Please attach your recent photograph and an A4-size photocopy of each of the following documents: 请将表格填妥并附上两寸近照一张，及以下文件A4影印本各一份:
· Identity Card and Residential Registration Document 身分证 以及 户口本
· Senior Middle School Report 高中学年报告, 含学习成绩单及操行评语
· Senior Middle Entrance Examination Results 初中毕业会考成绩单
· SM2 Mid-Year Examination Results 高二年中期末考试成绩单
· Award Certificates (if any) (e.g. National Mathematics Olympiad) 奖状（若有） （例如：全国数学奥赛省一等奖等）
5. Incomplete Application Forms will be rejected. 未经填妥的表格将被退回。
6. Please print the application on duplex prior to completion and submission. 请将表格双面 打印在A4白纸后再填写。
7. Please note that any false entry in the application will be rejected and will lead to the termination of scholarship award (if offered). 所提供的资料如果有误，申请将作废，奖学金将被撤销（如果已获颁）。
SM2/16
Scholarships forUndergraduate Studies in Singapore
2012新加坡企业奖学金
Application Form申请表格
Please complete thisform withthe photograph andattach a photocopy of the following documents:
请将表格填妥，并附上下列文件影印本各一份:
· IdentityCard and Residential Registration Document 身分证 以及 户口本
· SeniorMiddle School Report 高中学年报告, 含学习成绩单及操行评语
· SeniorMiddle EntranceExamination Results 初中毕业会考成绩单
· SM2 Mid-Year ExaminationResults高二年中期末考试成绩单
· AwardCertificates(if any)(e.g. National Mathematics Olympiad) 奖状（若有）（例如：全国数学奥赛省一等奖等）
(A) Personal Particulars 申请人资料
Name in Hanyu Pinyin (in BLOCK letters, underline surname)
汉语拼音姓名（用正楷书写，在姓氏底部划线）
Name in Chinese 中文姓名
Gender 性别*
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 无
_________
日日
月月
年年年年
1
9
Nationality国籍 *
China中国
F ________
Identity Card Number 身份证号码
Passport Number 护照号码
Email电子邮件
Have you previously applied for Permanent Residence (PR) in Singapore? 是否曾申请新加坡永久居留权？
Yes 是 If yes, please indicate your PR effective date (DD-MM-YYYY) :
如是，请注明永久居民权的有效期（日/月/年）: _________日_________月____________年
No 否
Have you ever studied in Singapore before? 是否曾在新加坡学习？
Yes是
No 否
If yes, please indicate 如是，请注明：
Name of school 学校名称:__________________________________________________________________________________
Period of studies (YYYY to YYYY) 在校时间: 从____________年至________________年
Home Address 住址 (请用中文填写)
Postal Code 邮编:
Home Number 住家电话号码
001－86－ －
区号 电话
Handphone No. 手机号码
其他电话号码: _____________________
(B) School Attended 学习经历（请用中文填写）
Name of schools attended including the present school (in chronological order).
Please state the province and city that the school is located.请用中文填写所就读过的学校（请按年序填写）
Primary School
小学
省
市
地址
Junior Middle School
初中
地址
Senior Middle School
高中
省
市
地址
*Please tick where appropriate. 请在正确的格子內标上?
(C) Examination Results：Class & Level Details班级与学年考试成绩资料
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.
请在下列栏项填上初中毕业会考成绩 [括号内请列满分, 如‘135 /150’],高一期末，高二期中考试成绩，以及你在班级与年级的排名。
Subject
科目
Senior Middle Entrance Examination Results
初中毕业会考成绩
SM1 Year-End Examination
高一期末考试成绩
SM2 Mid-Year Examination
高二年中期末考试成绩
得分
满分
得分
满分
得分
满分
Politics 政治
Chinese Language 中文
Mathematics 数学
Physics 物理
Chemistry 化学
Biology 生物
English Language 英语
History 历史
Geography 地理
Others 其他
Total Marks
总分
Class Ranking
班级排名
Class Rank
班级名次 Class Size
班级名额
Level Ranking
全级排名
Level Rank
年级名次 Level Size
学年名额
Living in Boarding School 现在是否居住在宿舍 *
Yes 是
No 否
Class Type
班类*
Science
理科
Experimental
实验
Arts
文科
Olympics
奥林匹克
Key point
重点
Hong Zhi
宏志
(D) Academic Achievements (eg 2011 National Mathematics Olympiad, 2nd in Province)
特出学术表现 ( 例如 : 2011年全国数学奥林匹克赛，省二等奖)
(E) Other Achievements 课外活动表现 ( 例如 : 校际篮球比赛冠军)
*Please tick where appropriate. 请在正确的格子內标上?
(F) Particulars of Family Members申请人家属资料
Please attach a separate sheet if there are more family members. 若家中还有更多成员, 请另附纸页书写。
Name of Father / Guardian in Hanyu Pinyin (in BLOCK letters, underline surname)
父亲/监护人汉语拼音姓名（用正楷书写，在姓氏底部划线）
Name in Chinese
中文姓名
Date of Birth 出生日期
Nationality国籍 *
China中国
_____________
Race 民族
Are you also a Permanent Resident of another country? 是否拥有其他国家永久居留权？
Yes是 If yes, please state country
如是，请注明国家 ___________________
No 否
日日
月月
年年年年
Province of Birth 出生地 (省)
Identity Card Number 身份证号码/ 户口登记号码
Passport Number 护照号码
Handphone No 手机号码/ 联络号码
Email address 电子邮箱
Name of Employer/ Company单位名称
Designation/ Position 职衔
Occupation Field/ Sector 职业领域
Administrative/ Clerical 行政/文秘
Building/ Construction 建筑/土木
Civil Service 政府机关
Education/ Training 教育、培训
Others (please specify)
其他 ，请注明
Engineering 工程
Accounting/ Finance/ Investment
会计、金融、投资
Corporate Support (Eg HR, Marketing)
企业经营（人力资源、市场营销等)
IT/ Programming 信息技术、程序编程
Legal 法律
Healthcare/ Medical 保健、医疗护理
Service Related
(Hospitality/ Tourism/ Food & Beverage)
服务类(酒店、旅游、餐饮)
Science/ Other R&D Related 科研
Highest Qualifications Attained 最高学历
Post Graduate Degree 研究生学位
Diploma 理工学院
Primary 小学
Degree 大学
Secondary/High School 初中/高中
No Formal Schooling 无正规教育
Others (please specify) 其他 ，请注明
_______________________
Name Mother in Hanyu Pinyin (in BLOCK letters, underline surname)
母亲汉语拼音姓名（用正楷书写，在姓氏底部划线）
Name in Chinese
中文姓名
Date of Birth 出生日期
Nationality国籍 *
China中国
_____________
Race 民族
Are you also a Permanent Resident of another country? 是否拥有其他国家永久居留权？
Yes是 If yes, please state country
如是，请注明国家 ___________________
No 否
日日
月月
年年年年
Province of Birth 出生地 (省)
Identity Card Number 身份证号码/ 户口登记号码
Passport Number 护照号码
Handphone No 手机号码/ 联络号码
Email address 电子邮箱
Name of Employer/ Company单位名称
Designation/ Position 职衔
Occupation Field/ Sector 职业领域
Administrative/ Clerical 行政/文秘
Building/ Construction 建筑/土木
Civil Service 政府机关
Education/ Training 教育、培训
Others (please specify)
其他 ，请注明
Engineering 工程
Accounting/ Finance/ Investment
会计、金融、投资
Corporate Support (Eg HR, Marketing)
企业经营（人力资源、市场营销等)
IT/ Programming 信息技术、程序编程
Legal 法律
Healthcare/ Medical 保健、医疗护理
Service Related
(Hospitality/ Tourism/ Food & Beverage)
服务类(酒店、旅游、餐饮)
Science/ Other R&D Related 科研
Highest Qualifications Attained 最高学历
Post Graduate Degree 研究生学位
Diploma 理工学院
Primary 小学
Degree 大学
Secondary/High School 初中/高中
No Formal Schooling 无正规教育
Others (please specify) 其他 ，请注明
_______________________
*Please tick where appropriate. 请在正确的格子內标上?
Name of Sibling 1 in Hanyu Pinyin (in BLOCK letters, underline surname)
兄弟或姐妹1, 汉语拼音姓名（用正楷书写，在姓氏底部划线）
Name in Chinese 中文姓名
Gender 性别*
Male男
Female 女
Date of Birth 出生日期
Nationality国籍 *
China中国
_____________
Race 民族
Are you also a Permanent Resident of another country? 是否拥有其他国家永久居留权？
Yes是 If yes, please state country
如是，请注明国家 ___________________
No 否
日日
月月
年年年年
Province of Birth 出生地 (省)
Identity Card Number 身份证号码/ 户口登记号码
Passport Number 护照号码
Handphone No 手机号码/ 联络号码
Email address 电子邮箱
Name of Employer/ Company/ School 单位名称, 若仍求学, 请注明学校
Designation/ Position 职衔
Occupation Field/ Sector 职业领域
Administrative/ Clerical 行政/文秘
Building/ Construction 建筑/土木
Civil Service 政府机关
Education/ Training 教育、培训
Others (please specify)
其他 ，请注明
Engineering 工程
Accounting/ Finance/ Investment
会计、金融、投资
Corporate Support (Eg HR, Marketing)
企业经营（人力资源、市场营销等)
IT/ Programming 信息技术、程序编程
Legal 法律
Healthcare/ Medical 保健、医疗护理
Service Related
(Hospitality/ Tourism/ Food & Beverage)
服务类(酒店、旅游、餐饮)
Science/ Other R&D Related 科研
Highest Qualifications Attained 最高学历
Post Graduate Degree 研究生学位
Diploma 理工学院
Primary 小学
Degree 大学
Secondary/High School 初中/高中
No Formal Schooling 无正规教育
Others (please specify) 其他 ，请注明
_______________________
Name of Sibling 2 in Hanyu Pinyin (in BLOCK letters, underline surname)
兄弟或姐妹2, 汉语拼音姓名（用正楷书写，在姓氏底部划线）
Name in Chinese 中文姓名
Gender 性别*
Male男
Female 女
Date of Birth 出生日期
Nationality国籍 *
China中国
_____________
Race 民族
Are you also a Permanent Resident of another country? 是否拥有其他国家永久居留权？
Yes是 If yes, please state country
如是，请注明国家 ___________________
No 否
日日
月月
年年年年
Province of Birth 出生地 (省)
Identity Card Number 身份证号码/ 户口登记号码
Passport Number 护照号码
Handphone No 手机号码/ 联络号码
Email address 电子邮箱
Name of Employer/ Company/ School 单位名称, 若仍求学, 请注明学校
Designation/ Position 职衔
Occupation Field/ Sector 职业领域
Administrative/ Clerical 行政/文秘
Building/ Construction 建筑/土木
Civil Service 政府机关
Education/ Training 教育、培训
Others (please specify)
其他 ，请注明
Engineering 工程
Accounting/ Finance/ Investment
会计、金融、投资
Corporate Support (Eg HR, Marketing)
企业经营（人力资源、市场营销等)
IT/ Programming 信息技术、程序编程
Legal 法律
Healthcare/ Medical 保健、医疗护理
Service Related
(Hospitality/ Tourism/ Food & Beverage)
服务类(酒店、旅游、餐饮)
Science/ Other R&D Related 科研
Highest Qualifications Attained 最高学历
Post Graduate Degree 研究生学位
Diploma 理工学院
Primary 小学
Degree 大学
Secondary/High School 初中/高中
No Formal Schooling 无正规教育
Others (please specify) 其他 ，请注明
_______________________
*Please tick where appropriate. 请在正确的格子內标上?
(G) Other relevant information其他相关资料
Please tick the appropriate box 请在正确的格子內标上?
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.
身体或心理健康是否出现过问题？如是，请说明。
Yes是 _______________________________________________________________________________
No 否
2. Have you ever been charged in a court of law in any country? If yes, please give details below.
是否曾在任何国家被控上法庭？如是，请说明。
Yes是 _______________________________________________________________________________
No 否
3. Have you previously applied for other scholarships to study in Singapore? If yes, please give details below.
是否曾申请过赴新加坡留学的奖学金？如是，请说明。
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.
是否曾获颁任何到新加坡留学的奖学金，但拒绝接受或终止该奖学金? 如是,请提供理由。
Yes是 _______________________________________________________________________________
No 否
5. Have any of your relatives been awarded scholarships to study in Singapore? If yes, please give details below.
是否有任何亲属曾获颁奖学金到新加坡留学？如是，请说明。
Yes是 _______________________________________________________________________________
No 否
Name of Relative
亲属姓名
Relationship关系
Name of Award
奖学金名称
Country of Award
颁奖国家
Period Held期间
(从xx年至xx年)
(H) ANTECEDENT OF APPLICANT 申请人背景
Please tick (√) where appropriate 请在适用处打勾(√)
(a) Have you ever been refused entry into or deported from any country, including Singapore?
您是否曾被任何国家(包括新加坡)拒绝入境或遣返回国?
□ Yes是 □No否
If the answer is “Yes”, please furnish details.
若以上答案为 “是”,请提供详情。
______________________________________________________________________________
______________________________________________________________________________
(b) Have you ever been convicted in a court of law in any country, including Singapore?
您是否曾在任何国家 (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.
若以上答案为 “是”,请提供详情。
____________________________________________________________________________________________________________________________________________________________
(c) Have you ever been prohibited from entering Singapore?
您是否曾被禁止进入新加坡?
□ Yes是 □No否
If the answer is “Yes”, please furnish details.
若以上答案为 “是”,请提供详情。
____________________________________________________________________________________________________________________________________________________________
(d) Have you ever entered Singapore using a different passport or name?
您是否曾用其他名字或护照进入新加坡?
□ Yes是 □No否
If the answer is “Yes”, please furnish details.
若以上答案为 “是”,请提供详情。
____________________________________________________________________________________________________________________________________________________________
(e) Did you reside in other countries, other than your country of origin, for one year or more during the last 5 years?
您是否在过去五年内, 除了在您所属国家外，在其他国家居留一年或以上？
□ Yes是 □No否
If the answer is “Yes”, please furnish details.
若以上答案为 “是”,请提供详情。
Country 国家
Address住址
Period of Stay居留日期
月月/年年年年
From 从
To 止
(I) Declaration by Applicant and Parent / Guardian
申请人与家长/监护人声明
Applicant申请人
1. I declare that the particulars provided in this application are true and that I have not wilfully suppressed any material fact. 我确定以上提供的资料全属真实，没有任何隐瞒。
我明白所提供的资料如果有误，我的申请将作废。如果我已获颁奖学金，奖学金将被撤销。
3. Certified copies of the relevant documents required are attached. 已附上相关的文件副本。
______________________ _______________________________
Date 日期 Signature of Applicant申请人签名
Parent / Guardian *父亲/母亲/ 监护人
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.
本人作为申请人的*父亲/母亲/监护人，同意他/她报名申请前往新加坡留学。
______________________ ___________________________________ ______________________________
Date日期 Name of *Father/Mother/Guardian Signature of *Father/Mother/Guardian
*父亲/母亲/监护人汉语拼音与中文姓名 *父亲/母亲/监护人签名
*Delete whichever is inapplicable 请在适当位置删除
Pleasenote that unsigned applications will be rejected
(J) Essay
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.
写一篇不超过500字的文章介绍自己、或谈述一个和你有切身关联的内容。例如: 一段影响你的经历、或讲述你的志愿；抑或介绍一名对你产生重要影响的亲人、朋友或人物。注意：这篇文章是奖学金申请的重要环节。
(__________ words / 个字)
