APPLICATION FORM FORHCI SCHOLARSHIPS 2017

Hwa Chong Junior College Alumni Undergraduate Scholarship

Instructions to applicants:

Complete and submit this application form,together witha scanned copy ofthe following supporting documents(in pdf format),to :

Sec 4 IP / GCE 'O' Level Examination results

JC2 Prelim transcript

GCE 'A' Level Examination results (if applicable)

Secondary School and JC CCA and CIP Records

Secondary School and JC Testimonials (if applicable)

Application deadline: 30April 2017

A.PERSONAL PARTICULARS

Full Name /
NRIC / Passport Number
CT Group
Date of Birth
Gender / Male / Female[*]
Nationality / Race
Marital Status
Residential Address
Postal Address
(if different from above)
Contact Number / (Home) / (Mobile)
Email Address
National Service Status (if applicable) / ORD Date

B.EDUCATION

Primary School
YearJoined / Year Graduated
Highest Standard Passed and Year
Secondary School
YearJoined / Year Graduated
Highest Standard Passed and Year
HCI JC2 Prelim Results / GCE ‘A’Level Results
Subject / H1 / H2 / H3 / Grade / Subject / H1 / H2 / H3 / Grade
HCI Diploma

1

Hwa ChongInstitution

Were you awarded the HCI Diploma? / Yes / No / Not applicable[†]
Type of HCI Diploma awarded / Diploma with Distinction / Diploma with Merit / Diploma*
Year of Award

Other Academic Qualifications:

C.SECONDARY SCHOOL AND JC CO-CURRICULAR ACTIVITIES

Activity / Position Held / Role Performed / Year

D.COMMUNITY INVOLVEMENT PROJECTS

Activity / Position Held / Role Performed / Year

E.PARTICULARS OF FAMILY

Name / Relationship / D.O.B / Marital
Status /

Occupation

/ Gross Monthly
Income

F.UNIVERSITY APPLICATION

Please provide details of overseas / local universities you have applied to.

Name of university / Course / Application Outcome

G.OTHER SCHOLARSHIP / BURSARY APPLICATION

Please provide details of other scholarships / bursaries you are currently holding or have applied to.

Name of Scholarship / Bursary / Application Date / Application Outcome

H.TEACHING SUBJECT PREFERENCE

Please indicate your preferred teaching subjects (if applicable).

Note: The recipient of the Hwa Chong Junior College Alumni Undergraduate Scholarship can choose to serve as a teaching staff of HCI.

Choice 1:
Choice 2:

I.ESSAY

In not more than 500 words, please describe some of your most significant contributions to the school or community during your course of study in HCI.

J.DECLARATION

Have you been charged with an offence in a court of law of any country? Yes/No[‡]

Are you suffering from any physical impairment, mental illness or disease? Yes /No*

If your answer to any of the above questions is ‘Yes’, please provide details in the box below:

  1. I declare that the particulars stated in this application form and attached documents are true to the best of my knowledge.
  2. I understand that HCI reserves the right to terminate the scholarship and I may be required to reimburse any part of the scholarship granted to me, if it is found that I have deliberately made a false declaration.
  3. I grant permission to HCI to verify the information in this application and the documents attached.

Signature of Applicant: / Date:

1

Hwa ChongInstitution

[*] Delete accordingly

[†]Delete accordingly

[‡]Delete accordingly