Coding Quest Camp

Adult Camp 2

Application Form

Fully sponsored by Microsoft and SPD, The Coding Quest, by Microsoft offers coding workshop to persons with disabilities. Participants will get to learn hands-on on digital literacy skills, designing, setting up of E-storeand many more.

Who are eligible?

  • Singapore citizens or Singapore Permanent Residence
  • Have physical and/or sensory disabilities
  • Age from 21 to 39 years old
  • Must have basic HTML skills

How to apply?

  • Complete the application form and ensure the following documents are attached for submission:

1)Photocopies (front and back) of NRIC/Birth Certificate

2)Student Pass/Matriculation Pass

3)Document to certify diagnosis / disability

Camp Details

Date: 4 to 8 June 2018

Time:9:30am to 5:00pm

Venue: Microsoft Office

1 Marina Boulevard, #22-01

Singapore 018989

Course Fee:FREE

  • Lunch will be provided for participants ONLY
  • Laptop/Desktop will be provided
  • There will be soft skills training by JA Singapore
  • Competition for the Best e-commerce Website (only for those who attended Camp 1)

Application Closing Date: 04 May 2018

ADULT CAMP 2

APPLICATION FORM

Closing Date: 04 May 2018

Section 1 : PERSONAL PARTICULARS
Name (as in NRIC):
NRIC No: / Gender: / Race:
Date of Birth: / Nationality: / Emergency Contact No:
Email Address (compulsory): / Home Contact Number: / Mobile Number:
Home Address:
Section 2 : NATURE OF DISABILITY
Type of diagnosis / disability:
Section 3 : EDUCATION DETAILS (if applicable)
Current Education Level: ______
☐Secondary ☐Pre-University/ Junior College ☐Institute of Technical Education
☐Polytechnic ☐University ☐Others (pls specify): ______
Name of School/Institution: ______
Section 4: ACCOMODATION

1) Do you use any mobility aids? Yes No
1a) If yes, what type of mobility aids you are using?
Manual wheelchair Motorised wheelchair Motorised scooter

Walking Stick Walking Frames Others (please specify): ______
1b) Do you need door-to-door transport? (Only for those with mobility issues e.g.: on wheelchair)
Yes No
If yes, please provide address if different from the above stated :
______
Note:
2 hours of journey to venue and 2 hours journey back home is expected due to:
  • Road congestions
  • Transport is picking up & dropping off other clients from various locations

Do you need Sign Language Interpreter? Yes No
What other accommodations do you need? Pls specify: ______
DECLARATION
I fully understand and agree that the personal information which I have provide, including health, medical, social, financial information and photographs, may be disclosed to other agencies, funders or individuals for the purposes as stated below.
  • For processing my application, including assessments and evaluations, for services, programmes and assistance offered by other organisations;
  • For professional discussions between SPD and other agencies involved in the provision of my application, for the purpose of enhancing service delivery;
  • For generating social, welfare, financial regulatory, management or other related reports and performance of analytics.
  • To relevant government authorities, ministries, statutory boards, agencies, funders or any person to whom disclosure is allowed or required by law, regulation or any other applicable instrument, for legal purposes;
  • For public education, advocacy, outreach, fund raising, and/or other related activities ;
  • Any other purposes related to providing you with the necessary and relevant assistance.
I declare that all information in this application (and documents attached, if any) are true to the best of my knowledge and belief, and I have not wilfully suppressed any material fact. I understand that SPD shall not be responsible for any accident that may occur during this event. I will not hold SPD responsible and will indemnify SPD against any claim.
Applicant’s Name / Applicant’s Signature / Date
For Applicants below 21 years of age:
Name of Applicant’s Parent/Guardian / Signature of Applicant’s Parent/Guardian / Date

Note:

  1. We will notify you via e-mail the status of your application after the closing date.
  2. Submit this application form with the required documents via email or post to :

Ms Farhanah (Schemes and Grants)

2 Peng Nguan Street

SPD Ability CentreSingapore 168955

Email:

For Official Use:
Documents checked :
Copy of NRIC (front and back)/Birth Certificate
Student Pass/Matriculation Pass
Document to certify diagnosis / disability
Application status :
 Accepted
Rejected
On waiting list
Date received: ______
Checked By / Date : ______
Approved By / Date : ______

Microsoft Coding Quest Camp

Singapore Personal Data Protection Act (PDPA)

Dear Participants,

Please be informed that there will be photography and/or videography in this event.

The photos/videos captured may be used in the production of instructional, promotional materials and for other purposes that the organizer deems appropriate and that such materials may be distributed to the public and displayed publicly one or more times and in different formats, including (but not limited to) websites, cablecasting, broadcasting, and other forms of transmission to the public.

I agreeto have my photos and videos taken at the event and allow SPD to use them for its communications and/or publicity related materials.

Applicant’s Name / Applicant’s Signature / Date
For participants below 21 years of age:
Name of Applicant’s Parent/Guardian / Signature of Applicant’s Parent/Guardian / Date

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