GRADUATE BIOMEDICAL SCIENCES SCHOLARSHIP

APPLICATION FORM: STRICTLY CONFIDENTIAL

Please read the instructions carefully before filling in the form
1. Please return the duly completed form to:
Economic Development Board
Biomedical Sciences Group
(ISK-EDB Scholarship Program)
Raffles City Office Tower,
250 North Bridge Road #28-00
Singapore 179101
2. Certified true copies of your birth and educational certificates, testimonies and other relevant
documents must accompany this application. All attachments must bear your name.
3. Please note that your application will not be considered if the particulars/information provided by you
are not accurate, or if you suppress any material information.
4. This form would take approximately 30-45 mins to complete.
5. The agencies do not enter into any correspondence with regard to the reasons for rejection of an
application.
6. Please note that only shortlisted candidates will be notified.

1. Personal Details
Mr./Mrs./Miss/Ms (Underline Surname) (Chinese Characters if applicable)

Permanent Address Tel No. (Home)

Mobile Phone
Email Address
Please provide Correspondence Address, if it is different from the Permanent Address.

NRIC Date of Birth Age Gender (please tick)

Male / Female
Country of Birth Citizenship (please indicate if PR) Religion

Race Dialect Group

2. Educational Details (Please attach all relevant certificates and transcripts)

Level Name of Institute From To Highest Standard Attained

University

Polytechnic

Junior College

Secondary

3. Language Skills
Language / Dialect Spoken Written

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 Basic Good Excellent N.A. Basic Good Excellent N.A.

Basic Good Excellent N.A. Basic Good Excellent N.A.

Basic Good Excellent N.A. Basic Good Excellent N.A.

Basic Good Excellent N.A. Basic Good Excellent N.A.

Basic Good Excellent N.A. Basic Good Excellent N.A.

4. Working Experience
Employer From (Year) To (Year) Job Title / Responsibility

5. Community/Sport/Recreation/Voluntary Activities
From To Level
Activity Involvement
(year) (year) Attained Award/Prize/Commendation

If you would like to furnish additional information, please attach in a separate sheet.

6. Awards
Description Year

7. Family Details

(a) Parents

Father’s Name
Family combined monthly Type of Dwelling
Date of Birth income (S$)

Occupation ο Below 500 ο Bungalow

ο 500 – 999 ο Semi-Detached
ο 1000 – 1999 ο Terrace
Name of Company
ο 2000 – 2999 ο Condominium &
ο 3000 – 3999 Private Apt
Mother’s Name ο 4000 – 4999 ο HDB 5-Room &
ο 5000 – 7499 Executive
Date of Birth ο 7500 – 9999 ο HDB 4-Room

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Occupation ο Over 10000 ο HDB 3-Room
ο HDB 1&2-Room
ο Other Public flat
Name of Company ο Others

(b) Siblings

Name of
Name Date of Birth Age Gender Occupation
Employer/School

8. National Service Records (if applicable)

(a) National Service Liability

From To Name of Commanding

Rank Name of Camp Camp Telephone No.
(Mth/yr) (Mth/yr) Officer

(b) I am exempted/deferred from National Service because

Please specify and attach supporting documents:

ο Medical Reasons

ο Others

(c) For those yet to be enlisted,

Expected Date of Enlistment

Camp

9. Declaration

8. Declaration
Please answer all the questions by circling “YES” or “NO” in the right hand margin.
If “Yes”, please give details below the question.
Have you ever been convicted in a court of law in any country? Yes / No

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Are you at present under any financial embarrassment? Yes / No

Have you any obligation under promissory notes either as principal or surety? Yes / No

Have you had any condition or problem, either physical or psychological, that requires professional Yes / No
care or that limited your activity in any way? Do you currently have any health problem?
If YES, please provide details on (on a separate sheet if necessary)

……………………………………………………………………………………………………………..

(Question for Non-Singaporean or Singaporean Permanent Residents only) Yes / No

Have you been a Singapore Citizen or Singapore Permanent Resident before?
If YES, please provide details on (on a separate sheet if necessary)
(a) Length and nature of stay in Singapore
(b) Date of confirmation of Citizenship/PR
(c) Date which Citizenship/PR was renounced

Have you applied for or been accepted by any scholarship programme?

Yes / No
If yes, please give following details:
Scholarship programme Discipline University Status of Application

9. Referees

Give particulars of two persons who know you well with regard to your character and work performance.

Particulars First Referee Second Referee

Name of Referee

Address

Email Address
Telephone No.
Occupation
Name of Organization
No. of years Referee has known you

Before appending your signature below, please ensure that you have read over the form very carefully, that every answer or
information given in this form is to your knowledge true and correct, and that you have not willfully suppressed any material fact.

Date: _______________________________ Signature: ___________________________

10. Tell Us About Yourself

Your response to the question below will help us better understand your aspirations and motivations. You are
requested to attach your completed response to this application form.

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Q. Share with us (a) the goals you have set for yourself and how you plan to achieve them
(b) why you have chosen to go into the biomedical sciences field

(Not more than 150 words)

a)

b)