MOE Bursary Application (Part-Time Diploma) AY2014/2015

Transcription

1 MOE Bursary Application (Part-Time Diploma) AY2014/2015 Important Notes 1. Complete the application form with clear and legible writing. It will take about 15 minutes to complete the form. 2. Do not use correction tape or fluid on this application form. Cancel and counter-sign against amendment instead. 3. Submit the completed application form with all required supporting documents in person to Student Wellness & Counselling Centre (SWCC) at Blk 30 Student Development Centre Level 4 by 13 June I STUDENT PARTICULARS Diploma: Admission No: Name as in NRIC: Couse Code: Yr of Intake: Course commencement date: Address: Modular Cert (MC) / Semester of Study: *1 / 2 / 3 / 4 / 5 Gender: * F / M MC/Sem Commencement: * April / Oct Citizenship: * S porean / SPR / Others Home Tel.: Mobile No.: Postal Code ( ) II PARTICULARS OF FAMILY MEMBERS (Immediate and non-immediate family members living together) Name Age Relationship to Student 1. Self NRIC / BC No. Marital Status Occupation For Student state in ( ) Pri, Sec, ITE, Poly, Uni Gross monthly income + other sources of income ($) III - ARE YOU CURRENTLY APPLYING FOR OR IN RECEIPT OF ANY OTHER BURSARY / SCHOLARSHIP / STUDY GRANT FOR AY14/15?. (Pls tick where applicable) No Yes (Pls specify: ) IV ACKNOWLEDEGMENT BY MOE BURSARY APPLICANT Total Monthly Income (A) PCI = A no. pax in hse hold 1. I declare that the information and supporting documents provided in this application are true and correct. I did not willfully withhold or suppress any other relevant information. I understand that submission of any false particulars will render my application void and that I will be required to refund Temasek Polytechnic the full sum of money received. 2. I have to refund up to the full award quantum if I voluntarily withdraw from my course of study or concurrently hold another bursary/scholarship^. 3. I understand the decision of the SWCC Bursary Committee is final. 4. I am aware that Temasek Polytechnic collects data on information given. I have no objection for Temasek Polytechnic to use the information given herein for statistical purposes. I can review Temasek Polytechnic s privacy statement online at * Pls delete where applicable Applicant s Signature: Date: SWCC0040 (VER.04), Last updated: 04/04/2014 1

2 MOE BURSARY (P/T DIPLOMA) AY 2014/2015 APPLICANT TO NOTE: 1) SWCC Bursary Committee will award quantum based on applicant s eligibility:- a. Singapore Citizen b. Students pursuing a part-time diploma at the polytechnic for the first time (not including repeat students for the AY/Semester/Module) c. ^Not receiving other scholarships / bursaries in AY2014/2015. However, students who are awarded scholarships/bursaries/study awards that cover tuition fees only can concurrently hold the MOE Bursary. d. Gross monthly household per capita income (PCI)** of $1,900 Gross Monthly PCI** Award Quantum Per Modular / Semester ^^ $1,400 and below $495 Between $1,401 to $1,900 $250 ** Per capita income (PCI) = Total gross monthly income of ALL family members Number of family members in the household ^^ Only applies to students from Modular Structure. Students are to apply bursary on modular basis. 2) Definition of Total Gross Monthly Family Income a. Includes employee s CPF contributions, income contributions from self-employment, business or salaried employment which include basic salary, allowances, overtime pay and other sources of income such as rent, alimony, pension etc. b. If bonuses are declared it should be computed as one twelfth of the annual wage supplements and bonuses received in the last twelve months. c. The monthly financial support from divorced/separated parent or spouse such as alimony and contributions to support children/household should be included. d. National Service (NS) allowance earned by NSF is excluded. 3) Immediate and non-immediate family members a. Immediate family members include spouse, children, parents and siblings living together with the applicant. b. Divorced/separated parent or spouse may be excluded from the headcount. c. Non-immediate family members include grandparents, siblings spouses, siblings children and any other relatives who are living together with the applicant. 4) Application Procedure a. Application Period : 26 May to 13 June 2014 b. Submit the application form with supporting documents (listed on page 3) in person to Student Wellness & Counselling Centre (SWCC) at Blk 30 Student Development Centre Level 4 Opening hours: Mon Fri, 8.30am to 6.00pm Closed on weekends and Public Holidays c. Forms submitted by post will not be entertained d. For any enquiries, please to swcc@tp.edu.sg 5) Notification of Application Outcome All applicants will be notified by post from Temasek Polytechnic. SWCC0040 (VER.04), Last updated: 04/04/2014 2

3 Bursary Application Supporting Documents Checklist Please tick in appropriate boxes. Copy of the supporting documents to be provided: 1. a) NRIC of applicant & ALL family members (both sides) b) For Full-time National Servicemen - photocopy of green SAF 11B (both sides) c) Birth Certificate only for those below 15 years of age d) Death, separation or divorced certificate 2. a) Admission cards of family members studying in Poly / ITE / University b) Enrolment letter for sibling who is awaiting entry to Poly / ITE / University c) NS Enlistment letter for sibling who is awaiting for NS 3. Applicant / family members who are employed: a) Latest payslip OR b) Employer s letter (dated in current month) verifying the monthly income (with company s official stamp) 4. Applicant / family members who are unemployed / retired / housewife or employed but not able to produce income document 3a or 3b, must provide:- a) CPF Contribution History for the last six months (eg. Oct 2013 Apr 2014) AND b) CPF Transaction History for the last six months (eg. Oct 2013 Apr 2014) AND c) Income declaration form (attached in Page 4) 5. Applicant / family members who are self-employed (eg. taxi driver, hawker etc): a) CPF Contribution History for the last six months (eg.oct 2013 Apr 2014) AND b) CPF Transaction History for the last six months (eg.oct 2013 Apr 2014) AND c) Income declaration form (attached in Page 4) AND d) Notice of Income Tax Assessment Go to Log in to My Tax Portal using SingPass or IRAS Pin Select View Correspondence/Notices Select Letters/Notices Select Notice of Assessment (Individual) for 2013 / 2014 Print Notices 6. Interbank GIRO Form (attached in Page 5) 7. The front page of applicant s bank book OR Top portion of applicant s bank statement (with information of A/C holder name & A/C No.) Note 1) CPF members with SingPass can obtain CPF Contribution and Transaction History Statement from CPF Board website at 2) Please approach CPF branches or Community Centres in person with NRIC or call CPF hotline: to obtain SingPass SWCC0040 (VER.04), Last updated: 04/04/2014 3

4 BURSARY APPLICATION DECLARATION OF INCOME I, Mr/Mdm/Ms,NRIC No:, *parent/guardian/sibling/relative of (applicant s name), hereby declare that:- Pls tick where applicable: My occupation is and my current income is $ per month. For self-employed person, latest Notice of Income Tax Assessment must be provided. I am currently unemployed. I am a housewife with income of $ per month. I am a retiree with *pension/income of $ per month. (I enclosed my last 6 months CPF Contribution & Transaction History. Required only if you are 70 years old and below.) I declare that the information provided above is true and to the best of my knowledge and I understand that if the information provided is false, this application will be rejected. The applicant also undertakes to refund the full value of this financial assistance received if any of the information above is subsequently found to be falsely declared. Signature of Informant Date BURSARY APPLICATION DECLARATION OF INCOME I, Mr/Mdm/Ms,NRIC No:, *parent/guardian/sibling/relative of (applicant s name), hereby declare that:- Pls tick where applicable: My occupation is and my current income is $ per month. For self-employed person, latest Notice of Income Tax Assessment must be provided. I am currently unemployed. I am a housewife with income of $ per month. I am a retiree with *pension/income of $ per month. (I enclosed my last 6 months CPF Contribution & Transaction History. Required only if you are 70 years old and below.) I declare that the information provided above is true and to the best of my knowledge and I understand that if the information provided is false, this application will be rejected. The applicant also undertakes to refund the full value of this financial assistance received if any of the information above is subsequently found to be falsely declared. Signature of Informant Date * Pls delete where applicable. / Do produce more copies for family members to declare their income (if necessary). SWCC0040 (VER.04), Last updated: 04/04/2014 4

5 Finance & Administration Department 21 Tampines Ave 1 Singapore Attn : Part-Time Student (CET) Financial Matters INTERBANK GIRO FORM (MOE BURSARY FOR CET COURSES) NOTES: 1. Please note that all fields below are compulsory. 2. Upon completion, submit the original form with your MOE bursary application: a. The front page of your bank book OR b. Top portion of your bank statement (information of account holder name & account no.) 3. Any alterations to the bank account information on this form must be endorsed by the bank account holder. No correction fluid is to be used. 4. This form is not required for last year MOE bursary awardees. Please credit all monies due to me to my bank account as per provided given below. Student s Particulars Name as per NRIC (In block letters): NRIC No: Admin No: Contact No: Mailing Address: Name of Account Holder As Per Bank s Record: Name of Banker (e.g. DBS Bank; POSB etc.): Our Bank Code, Branch Code and Bank Account No: Bank Code Branch Code Account to be credited I certify that the bank account above belongs to me and undertake to accept full responsibility for payment credited to the above bank account. Amounts so credited shall constitute valid discharge of obligations due to me. This authorisation shall continue to be in force until I have expressly revoked it by notice in writing delivered to you. In the event of a change of bank account, I shall inform you in writing 30 days in advance of the change. Name of Bank Account Holder Signature of Bank Account Holder/ Date SWCC0040 (VER.04), Last updated: 04/04/2014 5