APPLICATION FOR BCA ACADEMY BURSARY 2011/2012

APPLICATION FORBCA ACADEMY BURSARY 2011/2012Important Notes:a. This application is open to BCA Academy full-time Diploma students who are Singaporeans or SingaporePermanent Residents with a gross monthly household Per Capita Income to be $500.00 and belowb. Application closing date: 31 May 2011.c. Please attach photocopies of ALL relevant documents (e.g. birth certificate, exam results, testimonials, etc.) referred toin your application form. For enquiries, please contact Ms Aveline Ler at 62489927 or Ms Vivian Lee at 62489876.Course of Study:Diploma in Construction EngineeringDiploma in Design (Interior & Landscape)Diploma in Mechanical EngineeringDiploma in Strategic Facilities ManagementDiploma in Electrical Engineering And Clean EnergyDiploma in Construction Information TechnologyPersonal ParticularsFull Name (including alias) in BLOCK letters(underline surname):Chinese Characters (if applicable)…………………………………………….….………………..…………………………………………………………………NRIC / Passport No:Attach PhotographCountry of Birth: Singapore Malaysia PRC Others …………………Tel / Pager No:Citizenship: S’pore citizen S’pore PRSex: Male FemaleAddress in Singapore:…………………………………………………………….………………………………………………………………….Singapore ( )Date of Birth / Age:Marital Status: Single Married Divorced WidowedAddress in Country of Origin (for foreigners only): Travel Document (for foreigners only): YES / NOIf yes, please state:…………………………………………………………………Issue Date: …………………………………………………......……………………………………………………………………………………………………………………………………Expiry Date: ……………………………………………………Country of Issue: …………….……………….………………..FT DIPLOMA – Bursary Application Form – Rev Date: 18 Feb 11 Page 1 of 5

Extra-Curricular ActivitiesSchool/InstitutionFrom(Year)To(Year)ActivityHighest positionheldLevel ofparticipation(Class, school,national, etc)Other AchievementsList other qualifications, achievements or hobbies that you would like us to know.Previous EmploymentGive in chronological order, a complete record of your previous employment, if applicableName of company Appointment From To GrosssalaryFT DIPLOMA – Bursary Application Form – Rev Date: 18 Feb 11 Page 3 of 5

Application for Scholarships and AwardsHave you previously applied or are currently applying for any scholarship or awards? Yes NoPlease specify below: Family Particulars (for Bursary applicants only)NameRelationshipMaritalStatusFatherMotherBrotherSisterAge Occupation MonthlyIncome** Original evidence of salaryare to be attached.National Service (if applicable)Full-time NationalServiceFrom(date)To(date)Last rankheldVocationLast unitNS ReserveServiceMedical FitnessStatusRank UnitPESFT DIPLOMA – Bursary Application Form – Rev Date: 18 Feb 11 Page 4 of 5

Are you suffering from any physical impairment or disease? Yes No if yes, please give detailsOther InformationAre you currently a recipient of any study loan, scholarship or bursary?Yes No if yes, please give details, viz, name of loan or scholarship, duration and amountHave you ever been charged in a court of law in any country, or do you have any court case or police investigation pendingagainst you?Yes No if yes, please give detailsDeclaration by ApplicantI hereby declare that all the information given in this application form and the attachments are correct and true tothe best of my knowledge and belief, and that I have not wilfully suppressed any material fact.Signature of applicantDatePlease submit duly completed application forms to:Training Administration DepartmentBCA Academy200 Braddell RoadSingapore 579700FT DIPLOMA – Bursary Application Form – Rev Date: 18 Feb 11 Page 5 of 5