Working Professionals Application Form: Faculty of Science Summer/Winter School Programme
Title / First name / Last nameJob title / Company / Job function
Email address / Mobile / Office phone
Office address
Residential address
(in Singapore)
Special requirements / Please indicate if you have special requirements (diet, disability, etc.):
How did you hear about this programme?
Authorisation : Details of organisation submitting application
Name / Job title
Office address
(if different from above)
Email address / Office phone
Signature / Date
I am interested to take up the following course(s):
Course Number / Course Title / Course FeesRegistration Fees
Total Fees
Please share your desired learning objectives from the course (Maximum 200 words)
DATA PROTECTION/DECLARATION
Information collected on this form will be held in accordance with the Advisory Guidelines under the PDPA (Personal Data Protection Act) for the purposes of processing your application. I hereby grant to NUS’ Faculty of Science the right and permission to take, use and publish photographs and video recordings in which I appear in printed or electronic media, including the internet, for promotional educational activities.
Signature:
Date:
Please indicate you do not wish photographs and video recordings of you to be used as described above.
STATEMENT
I confirm the information I have given in this application is, to the best of my knowledge, complete and accurate and that I have read the Terms and Conditions associated with the course. By registering for courses at NUS’ Faculty of Science, I agree to abide by university policies and procedures, including those related to the Faculty’s Summer/Winter School programme. I understand that I am required to submit payment for Summer/Winter courses, regardless of completion. If I withdraw from the course, I understand that I will not be awarded academic credits and/or industry certification and that additional fees will apply should I seek re-enrolment.
Signature:
Date:
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