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EAST ASIA Institute of Management (A registered MOE School No: 3037; formerly known as East Asia School of Business & wholly-owned by EASB Institute of Management Pte Ltd(EASB) Regn No.:200101029C)

Scholarship Application Form (local & overseas)

EASB-LIONS Scholarship Program INSTRUCTIONS: (1) This Application form must be completed in full in accordance with the instructions on the form. Failure to comply with the instructions may jeopardize your application. False particulars or willful suppression of material facts will render you liable for disqualification and dismissal if admitted to the school after award. (2) A copy each of your identification card, educational certificates and testimonials must accompany the application. Kindly certified all documents. (3) EASB does not enter into correspondence with regard to the reasons for selection of applicants. (4) Please submit your Scholarship Application Form in a sealed envelope to The Registrar Office, EAST ASIA Institute of Management, 9 Ah Hood Road, Singapore 329975. (5) All application for EASB Scholarship submitted to EASB must meet the eligibility criteria and satisfy all conditions of the award.

Personal Details FULL NAME AS IN NRIC (underline surname)

POSTAL ADDRESS (Local / Overseas)

* Mr / Mrs / Miss / Madam

Postal Code ( Name in Chinese Characters, (if applicable)

DATE OF BIRTH (DD / MM / YY)

COUNTRY/ STATE OF BIRTH

AGE

RACE

CITIZENSHIP

)

E-MAIL ADDRESS

RELIGION

MARITAL STATUS *Single / Married / Divorced

HOME TEL. HANDPHONE NO.

BIRTH/ CITIZENSHIP CERT NO.

NRIC NO. or Passport No.

*Pink / Blue IC (S’pore /Malaysia) Purpose of Scholarship Application

Please list the Program or course/s you are intending to apply to : (DETAILS OF EASB Institute of Management course/s, applicable for undergraduate studies only) Name of University / Schools

*Delete where not applicable

Name of Course Applied


DETAILS OF EDUCATION

GCE ‘O’ Level or Year 10 equivalent in foreign countries

GCE ‘A’ Level or Year 12 equivalent in foreign countries

Name of School

Name of School

Year of Graduation Grade

Subjects Taken

Year of Graduation Grade

Subjects Taken

OTHER EDUCATIONAL INFORMATION (e.g. professional qualifications, or course currently pursued). If you have already taken the TOEFL, SAT & Achievement tests and any other relevant test, please state scores.

For overseas applications, please indicate whether you have taken the EASB Approved Test Centre’s examinations? YES / NO If yes, please indicate the date of examination.

Date of Examination:

EXTRA CURRICULAR ACTIVITIES (secondary, colleges/pre-University) Uniform Groups, Society Committees, Clubs, Associations, Organisations etc. Name of Group

Year

*Level of Participation

Name of Group

Year

*Level of Participation

*Level of participation: example could be a member; committee member; class or school representative in sports, games or contest; chairman of club or society; etc.

AWARDS, COMMENDATIONS, PRIZES, CERTIFICATES ETC. Type of Award

Year


LANGUAGE PROFICIENCY LANGUAGE/S Level of Proficiency in each language (advanced or elementary) Written and spoken

Spoken only

1. 2. 3.

Full Name: Country of Birth: IF MARRIED, STATE PARTICULARS OF SPOUSE

Citizenship:

Occupation: Name of Employer:

Father’s Name

Country of Birth

Address

Occupation / Profession

Mother’s Name

Country of Birth

Address

Occupation / Profession

Citizenship

PARTICULARS OF PARENTS Citizenship

Occupation

Years Known

Occupation

Years Known

Name:

CHARACTER REFEREES Name two persons (other than relatives) who know you well

Address: Tel No.:

Name: Address: Tel No.:

*Delete where not applicable


GENERAL QUESTIONS Please answer the following questions by inserting ‘YES’ or ‘NO’ in the boxes provided. If ‘YES’, give details below:

Have you been or are you suffering from any physical impairment, disease or mental illness?

Yes / No

Have you ever been convicted in a Court of Law in any country?

Yes / No

Have you ever been discharged or dismissed from the service of the Singapore Government or of any Statutory Board in Singapore or of any Government of any country or any corporate employment/s? (if applicable)

Yes / No

Have you ever resigned from the service of the Singapore Government or of any Statutory Board in Singapore or of any Government of any country? (if applicable)

Yes / No

Details, if any, of physical impairment, disease, conviction, discharge, dismissal or resignation, with regard to the preceding questions.

*Delete where not applicable

DECLARATION: I ............................................................................................................ declare that all the particulars in this application and the attached sheets are true to the best of my knowledge and belief, and I have not willfully suppressed any material fact. I confirm having read the prevailing terms and conditions governing Scholarships, Education Grants and Bursaries. I fully understand, accept and abide by the prevailing terms and conditions; and that they may change without any prior notification to me.

Date of Application : ________________

Signature : _________________________________

________________________________________________________________________________________________________________ FOR OFFICIAL USE ONLY Comments by Awarding Panel:

Approved by the Chairman of Scholarships Award Committee: ________________________________________

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