SIVADAS-HEB EDUCATION FUND TERTIARY STUDENTS EDUCATION ASSISTANCE SCHEME APPLICATION FORM This application is for: Education Grant / Tuition Subsidy * NOTES TO APPLICANTS: The application form is to be completed by the student applying for assistance.  Applicants who have previously applied for and received the Education Grant or Tuition Subsidy need not apply again.  The application form must be endorsed by the Parent or Guardian if the applicant is below the age of 18.  Applicants must attach copies of educational certificates and documents with the application and produce orginals when called for an interview.  Details of all family members living in the same household must be included  Please provide a copy of the latest payslip, income declaration or letter from employer for all employed members of the family who are living in the same household.  Please provide a copy of Student IC, Student ID Proof & Parents IC.  Endorsement by student affairs department of private tertiary institute.  Closing date for applications is 17 June 2015.  Please delete accordingly (I) APPLICANT’S PARTICULARS (AS IN I/C) Name : Date of Birth : ___________________ Gender : IC No : __________________ Citizenship : Singaporean / PR * Race Male / Female * : _____________________ Religion : _____________________ Marital Status : Single / Married / Separated / Widowed / Divorced * Home Address: Blk _________________ Unit No. # _________________________ Street Name : ____________________________________________________________________ Postal Code : _______________________ Tel No : ___________________________ (Home) ________________________ (Mobile / HP) (compulsory) Email : ____________________________________________(compulsory) Type of Dwelling:1-room / 2- room / 3-room / 4-room / 5-room / Others (pls specify) * : ____________________________ Ownership: Purchased / Rental* Occupation (if not working, state “Unemployed” and duration of unemployment) Name and Address of Employer Gross Monthly Income (Total Income before CPF deduction, excluding allowances, if any) Part II-A - To be completed by applicants for Tuition Subsidy Part II-B - To be completed by applicants for Education Grant (II-A) To be completed by applicants for Tuition Subsidy Name of Private Institution: ____________________________________________________________________________________________ Address : ________________________________________ Tel No : __________________________________ Name of Degree/ Diploma: ____________________________________________________________________________________________ Name of Conferring Institute: ____________________________________________________________________________________________ Month/Year Started/ Starting: __________________ Expected Month/Year of Completion: ___________________ Total Fees: ______________ (Please attach a schedule of fees payable) Fee Breakdown Year Fee (S$) Schools attended, excluding the one in which you are currently enrolled. In sequence, list your most recent institution first (please attach transcripts for each institution, where necessary) Year Started Year Completed Name of Institute Qualification Earned Part II-B - To be completed by applicants for Education Grant Name of Local Tertiary Institute: ________________________________________________________________ Year of Study/ Matriculation or Student ID Number: _____________________________________ Please provide documentary proof of Admission to Tertiary Institute (III) EDUCATION ASSISTANCE RECEIVED / APPLIED FOR Are you receiving any educational assistance currently? Yes / No * (if yes, please provide details) Name of Organisation Amount (IV) PARTICULARS OF ALL FAMILY MEMBERS (WITHIN HOUSEHOLD) Name Relationship to Applicant NRIC Date of Birth Education Level Occupation Self Total ($) Gross Monthly Income (V) DECLARATION TO BE COMPLETED BY APPLICANT AND PARENT OR GUARDIAN (IF APPLICANT IS BELOW 18 YEARS) 1. I hereby declare that the particulars contained in this application are true and correct. 2. I understand that the committee reserves the right to verify the above information in whatever means deemed fit and necessary. I understand that any misreporting of the above information can lead to my application being rejected. 3. I understand that the acceptance of this application form by the Sivadas-HEB Education Fund does not bind the Fund to approve the application and the committee’s decision is final. 4. I will endeavour to study hard and complete the course, to the best of my ability. ________________________________ Name of Applicant _______________________ Signature of Applicant _____________ Date I consent and will support my child who is making this application as a minor (below 18 years of age) ___________________________________ Name of Parent / Guardian ________________________ Signature of Parent / Guardian ____________ Date (VI) ENDORSEMENT BY STUDENT AFFAIRS DEPARTMENT OF PRIVATE TERTIARY INSTITUTE I confirm that Student (name) ____________________, IC No:_________________, is enrolled / has been offered a place* in our Institution to pursue a course in _______________ leading to the award of (qualification) ________________ commencing on ____________. ___________________________________ Name & Designation ________________________ Signature ____________ Date ___________________________________ Name / Stamp / Seal of PEI (VII) FOR OFFICIAL USE Application : Approved / Not Approved Amount Approved: $____________ for the period ___________to ______________. Remarks : __________________________________________________________________________ Approved by: Signature: :__________________ ______________________ _______________ Name and Date :__________________ ______________________ ________________ You may mail or fax or handover in person the completed form with the supporting documents to: Sivadas – HEB Education Fund c/o Hindu Endowments Board 397, Serangoon Road, Singapore 218123 Tel: 6593 9209, Fax: 6292 9766 Web Site: www.heb.gov.sg E mail: [email protected]