Overseas Industrial Training / Immersion Programme Application Form ... that any pulmonary, nervous or mental trouble, a
SINGAPORE POLYTECHNIC INTERNATIONAL Overseas Industrial Training / Immersion Programme Application Form Name of Programme:
Date:
to
Full Name (As in passport and underline surname):
Course & Class:
School :
Nationality:
Affix Recent Passport Sized Photograph Here
Admission No:
Singapore Citizen Singapore PR
Others, please specify:
Blood Group:
Gender:
Race:
Religion:
Date of Birth:
Age:
NRIC No:
PSEA balance:
Passport No:
Place of Issue:
Date of Issue:
Date of Expiry:
Home Address:
Contact Details
Home Tel:
Handphone No:
Email:(Please make sure it’s a valid address)
Name of Next-of-Kin:
Relationship: (Parent / Sibling / Relative / Guardian)
Address of Next-of-Kin:
Contact Details of Next-of-kin
Home Tel:
Handphone No:
Office Tel:
Email:(Please make sure it’s a valid address)
SPI-FRM-QP101
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Your Medical History (it is particularly important that any pulmonary, nervous or mental trouble, asthma related respiratory disorder, cardiovascular problem, previous prolonged illness, allergy, etc. should be stated)
Are you under any prescription medication?
Description of Any Drug / Food Allergy :
Description of Any Dietary Restriction (e.g. Vegetarian, Halal, etc) :
Declaration of Family Members Living in the Same House Name
Age
Relationship to Applicant
Occupation
Marital Status
Gross Monthly Salary (S$)
Total Monthly Family Income
Monthly Per Capital Income
Have you previously received any funding from SP for overseas programmes (if yes, please specify details)
Are you a previous recipient of CDC or MOE funding (if yes, please state the year)
Do you wish to apply for SPOP Award and GLO Scholarship for this overseas attachment? YES / NO
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Terms and Conditions for the SPOP Award and GLO Scholarship 1. Qualified students who are Singaporean or Singapore PR (not returning to country of origin) will be awarded SPOP Award and/ or GLO Scholarship. 2. The total cost of OITP / OIP includes return economy class air-ticket, application fee for visa (if applicable), insurance, overseas and local training fees, and daily living allowance etc. 3. Successful applicants of the SPOP Award and/ or GLO Scholarship will be informed of the amount approved, subject to final cost of trip. 4. Successful applicants need to sign a “Letter of Undertaking & Health declaration” & “Rules and Regulation form” to participate in the OITP / OIP. -----------------------------------------------------------------------------------------------------------------------------------------------DECLARATION OF INFORMATION I declare that the information stated in this application and the attachments are true to the best of my knowledge and belief, and I have not wilfully suppressed any material facts. I understand that falsification of qualification or any other information may lead to the withdrawal of any offer of award, scholarship, or termination and subject myself to compensation charges as deemed necessary by Singapore Polytechnic.
_______________________ Signature of Student & Date -----------------------------------------------------------------------------------------------------------------------------------------------(Below is applicable to students under 21 years old. Please obtain approval from your parents/guardian)
CONSENT FROM PARENT/GUARDIAN I ________________________________________, the father/mother/guardian give consent for my *son/daughter/ward _________________________ to be involved in the Overseas Industrial Training Programme / Overseas Immersion Programme. .
_____________________________ Signature of Parent/Guardian & Date
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For Official Use Certified by the Polytechnic (Please tick appropriate box) This is to confirm that the student’s information provided above is correct and verified against the supporting documents provided by the student Applicant CGPA Per Capital Income Total Estimated Cost of Trip SPOP Award For students with CGPA < 2.5, Recommendation by School Director (If Applicable)
Approved by : (Name / Designation / Date)
Awarded Percentage (Filled in by SPI)
60%
50%
40%
GLO Scholarship For students with CGPA < 3.5, Recommendation by School Director (If Applicable)
Approved by : (Name / Designation / Date)
Remaining Cost (To be filled in by SPI) Awarded Amount
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Checklist of Documents to prepare Please provide evidence of your family household income i.e. form of pay slip/IRAS Notice of Assessment for verification (information will be treated strict confidentiality of data) Checklist of documents to prepare S/No
Documents Required
1
Applicant’s Particulars Singaporean - Photocopy of NRIC (front and back) Non Singaporean – NRIC or citizenship certificate
2
3
Family’s Particulars - NRIC (front and back) of parents, siblings and those living in the same household - Birth Certificate of siblings if without NRIC If NRIC is lost, please produce the police report concerning the loss. If address reflected on NRIC is different from applicant, a letter of explanation is required.
ONE OF THE FOLLOWING - Proof of Family Income (for each adult) For each working adult a) Latest Pay slip for all working adults or b) Letter from employer (with company stamp or official letterhead) stating salary or c) CPF Contribution/ Transaction History statement^ (showing transactions for the last 12 months) or d) Latest Income Tax Statements for self-employed adults (eg. Taxi driver, hawker etc)
For each unemployed adult (eg. Housewife) e) CPF Contribution/ Transaction History statement^ (showing transactions for the last 12 months) - If you are using (c), (d) or (e), you have to provide the Income Declaration Form. 4
5
Non-Working Siblings (if applicable) - Student pass or ezlink card for full-time students - Green ID for full-time NS men Other Documents (if applicable) Relevant documents that support your application e.g. medical report, death certificate, divorce document and retrenchment letter, court order.
Key *Pls delete where applicable ^To get this statement, one can either use one’s Singpass to log into www.cpf.gov.sg or to obtain it personally at a CPF service centre. SPI-FRM-QP101
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NOTE 1. All information on income must be accompanied by latest payslips, CPF statements or income tax statements. If, for valid reasons, these supporting documents are unavailable, please submit a completed income declaration form. 2. The gross monthly per capita income is computed based on the total income of immediate and nonimmediate family members over the total number of immediate and non-immediate family members, where a. Immediate family members include spouse, parents and all children who may or may not be living together with the student. Divorced/separated parent or spouse may be excluded from the headcount. b. Non-immediate family members include grandparents, siblings, spouses of siblings, siblings of parents, and any other relatives who are living together with the student. c. Income = gross (i.e. including employee’s CPF contribution) income contributions from all immediate and non-immediate family members from self employment, business or salaried employment (which includes basic salary, allowances, overtime, etc) as well as other sources of income (e.g rent). If bonuses are declared, it should be computed as one twelfth of the annual wage supplements and bonuses received in the last twelve months. The monthly financial support from divorced/separated parent or spouse such as alimony and contributions to support children/household should also be included. Payments in kind, reimbursement for transport and other expenses and National Service (NS) allowance earned by NS men are excluded. 3. If employed, state occupation. Otherwise, state unemployed, housewife, deceased, divorced, separated or performing NS. 4. Award given will be withdrawn if any information provided is falsely declared. 5. The decision made by Singapore Polytechnic is final. PSEA Withdrawal For those who are using their PSEA, please duly fill in the PSEA Ad Hoc Withdrawal Form and ensure there’s sufficient claimable amount in the account. You may call MOE’s PSEA enquiry line at (65) 6260 0777 to find out your total balance in your PSEA. ALL REQUIRED DOCUMENTS AND THIS APPLICATION MUST BE SUBMITTED AT LEAST TWO MONTHS BEFORE THE DEPARTURE DATE OF THE PROGRAMME TO: Singapore Polytechnic International Pte Ltd Singapore Polytechnic T5 01 500 Dover Road Singapore 139651 E-mail:
[email protected] Tel: 6870 8077 Fax: 6775 1263
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