Needy Pupil Fund (Non-Singaporeans).pdf - HCI EdTech Wiki - Hwa ...

HWA CHONG INSTITUTION (HIGH SCH)
APPLICATION FOR HCI NEEDY PUPILS FUND
Grants will be valid for the year of application only.
P09
Laptop
Subsidy
Programme
Section I: Particulars of Student
Full Statutory Name (Underline Surname): Class : BC/NRIC /FIN
No:
Home Address:
Current ISB subsidy,
if any:
100%/90%/75%/50%
/33%*
Nationality:
Confirmation of
IS B status by
Admin Office
(= awarded )
Singapore(
) Contact No:
Current Recipient of bursary or scholarship, if any
e.g. EESIS/ESIP/AEP/SAP:
Name of bursary/scholarship Date of expiry Value of award
Confirmation of status by Admin Office
( : awardee)
Section II: Particulars of Family Members (if you are currently an IS Bursary recipient, you
need NOT complete this section)
a) List down particulars of family members residing in the same household or who contribute to the income
of the household.
b) ‘Dependent children’ refer to unmarried children under16 years of age or unmarried children over 16 years
receiving full time education, or unmarried handicapped children.
c) Deceased/separated/divorced status of parents is to be indicated in 'Age' Column.
d) Submit a photocopy of each supporting document of the following for verification purposes:
- Family Income (employer’s letter or recent pay slip or latest Income Tax Assessment Return)
- ‘Unemployed’ Status of parent including housewife (written declaration)(form obtainable from admin
office)
- For self-employed family members (latest Income Tax Assessment Return)
Name
BC/NRIC/FIN
No.
Age Relationship Occupation/
Student
Name of
Employer/School
Gross
Monthly
Income $
Add Other sources of income (if any)
Name of organisation giving assistance
Amount per month
Total
Income verified by
Admin Office( )
1

Section III: Other considerations (eg: dependents with medical needs, sudden loss of breadwinner)
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Section IV: Purpose of Fund
Offer details (attach supporting documents)
E.g. School fees (only
applicable to Non-ISB
recipients)),
Exchange programmes,
School camps, CCA
coaching fees
Total Cost
$
$
Subsidy
applied for
Section V: Declaration
1. I declare that the particulars provided above are true to the best of my knowledge
2. I undertake to refund the value of financial assistance received if any of the information is
subsequently found to be false.
Name of Parent/Guardian: Mr/Mrs/Mdm _______________________________________________
Signature of
Parent/Guardian: ________________________________ Date: ________________________
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Section VI: To be completed by school
Status of Application: Approved Rejected
Income Ceiling GHI < $1,500
GIPDC < $600
$ 1,501 - $2,500
$ 601 - $1,000
$2,501 - $3,750
$1,001 - $1,500
$ 3751 - $4,500
$1,501 - $1,800
$ 4,501 - $7,200
$1,801 - $2,900
Category of
applicant
Recommendation by
approving panel
w..ee...f
ff: ::
• GHI: Gross Household Income GIPDC: Gross Income per Dependent Child
If the quantum applied for is
Approving Panel
< $ 2,500 DPSPSS , DPAE or DSC / SC
> $ 2,500 DPSPSS , DPAE, DSC or SC
Approved by DPSPSS
Approved by DPAE
Approved by DSC / SC
signature
signature
signature
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DDaat ttee: ::
P09 (Revised 9 Oct 08)
DDaat ttee: :: DDaat ttee: ::
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