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APPLICATION FORM
SHGs COLLABORATIVE TUITION PROGRAMME (CTP) 2015
ETF SCHOOL ASSISTANCE SCHEME (ETF-SAS) & FEE WAIVER
IMPORTANT INFORMATION
Please read instructions carefully before completing the application form.
Open to all students who are Singaporeans or Singapore
Permanent Residents.
 2014 year-end examination results of between 35 and 65 marks
per tuition subject (English and Mathematics for all levels and
Science for Primary 4 to Secondary 5).
 Gross Monthly household income of $3000 and below or the
family’s per capita income (PCI) of $800 and below.
 Net total family income of applicant must not be more than
$1,800 per month or the family’s per capita income (PCI)
per month must not be more than $450.

Students with overall results less than 75% MUST
register for MTS/CTP in order to be eligible for ETF
SAS
Parents are encouraged to attend the Financial
Literacy Workshop (Core Module) conducted by
Yayasan MENDAKI.

Eligibility
Criteria
(CTP)
Eligibility
Criteria
(ETF-SAS)

 To request from registration officer the tuition fee waiver
Fee Waiver for
Non
Malay/Muslim
students
 English (Primary 1 – Secondary 5)
application form for respective Self-Help Group.
 Submit the fee waiver application form together with MENDAKI’s
Level &
Subjects
 Mathematics (Primary 1 – Secondary 5)
 Science (Primary 4 – Secondary 5**)
**Combined Science only for Physics and Chemistry.
application form.
 Registration fee: $10 (non-refundable)
 Book Fee: $15
Registration &
Tuition Fees
(Not
applicable to
ETF-SAS
applicants)
 Primary 1 – 3: $8 per subject per month (9 months)
 Primary 4 – Secondary 5: $12 per subject per month (9 months)
 Fee for the whole year.
CTP
1 Subject
2 Subjects
3 Subjects
Pri 1-3
$97
$169
NA

Mode of
Payment
(Not
applicable
to ETF-SAS
applicants)




Note: Payment to be made upon receipt of the
notification letter.
Cash, NETS (Selected registration centres)
Cheque, Money Order, Postal Order (Payable to: Yayasan
MENDAKI)
GIRO (POSBank/DBS Bank)
Payment by Internet banking can be made at
http://mts.mendaki.org.sg/
Pri 4 - Sec 5
$133
$241
$349
(Inclusive of $10.00 registration fee and $15.00 book fees)
All students in our scheme will be insured against injuries while attending the tuition classes.
GIRO for CTP

To participate in GIRO, you must use your DBS / POSBank Savings / Current
Account only.

The account holders must be 18 years and above to authorise GIRO deduction.

Closing date for GIRO application is 8 May 2015.
Level / Date
12 or 27
Feb
12 or 27
March
10 or 30
April
12 or 29
May
Sufficient funds must be maintained in the account to meet the full
payment of the fees.
In the event that a deduction could not be made, a penalty of $2.00
will be charged to the account holder in the following month’s
deduction. The deductions are tentatively scheduled as follows: -


12 or 26
June
10 or 30
Jul
P1 to P3
$8 per subject per deduction
P4 to S5
$12 per subject per deduction
12 or 28
Aug
11 or 30
Sep
12 or 30
Oct

The depositor must request termination of GIRO service in writing to the Education Programmes Unit, Yayasan MENDAKI or DBS / POSBank. At least one month’s
notice must be given for the termination to be effective.

Your deduction will be reflected in your Passbook Statement of Account as “SHG”(Self-Help Group).
Submission of Form can be done at the following places.
WISMA MENDAKI
51 Kee Sun Ave, Singapore 457056
MENDAKI @ Heartlands
Pasir Ris
Blk 253, Pasir Ris St 21, #01-233, Singapore 457056
MENDAKI @ Heartlands
Woodlands
1 Woodlands St 81, #03-01, Woodlands CC, Singapore
738526
Certis CISCO Centre
Ground Floor, Reception Counter, Centre 1
20 Jalan Afifi, Singapore 409179
For more information, please call us at: 6551 2830
Monday to Friday: 8.30am – 5.30pm
Email us at [email protected] or [email protected]
Yayasan MENDAKI, 51 Kee Sun Avenue, off Tay Lian Teck Road S(457056)
Monday – Friday
Saturday
Sunday & Public Holidays
8:30am – 6:00pm
8:30am – 1:00pm
Closed
Monday – Friday
Saturday
Sunday & Public Holidays
9am – 6pm
9am – 1pm
Closed
Monday – Friday
Thursday
Saturday
Sunday & Public Holidays
9am – 6pm
9am – 8pm
9am – 1pm
Closed
Monday-Sunday: 8am - 9pm
Applications received by 7 December 2014 will be processed for admission in midJanuary 2015. Successful applicants will be notified by post in end December 2014 or
early January 2015. Applications received after 7 December 2014 will be processed for
admission in the subsequent months. Cut-off date is on the 7th of the previous month.
Eg. Cut-off date for admission in March is 7th February 2014.
COLLABORATIVE TUITION PROGRAMME 2015 CENTRE LISTING
S/NO
1
2
3
4
S/NO
5
S/NO
6
S/NO
CENTRE
Mon (Eng), Wed
(Maths), Fri (Sci)
Bukit Panjang Primary
School*
Lakeside Primary School
Telok Kurau Primary
School*
Yio Chu Kang Primary
School
CENTRE
Tue (Sci), Sat
(English/Maths)
Jing Shan Primary School
CENTRE
Mon (Maths), Fri
(Science)
Eunos Primary School*
(Only Pri 4-6)
Eunos Primary School*
(Pri 3 only Maths)
CENTRE
Saturday
(English/Maths)
CENTRE
CODE
ADDRESS
TIME
BPPS
109 Cashew Walk S(679676)
7.30pm - 9.00pm
LKPS
161 Corporation Walk S(618310)
7.30pm - 9.00pm
TKPS
50 Bedok Reservoir Rd S(479239)
7.30pm - 9.00pm
1 Hougang Street 51 S(538720)
7.30pm - 9.00pm
YCKPS
CENTRE
CODE
SPJS
CENTRE
CODE
ADDRESS
TIME
Tue: 6.00pm - 7.30pm
Sat: 8.30am - 11.45am
5 Ang Mo Kio Street 52 S(569228)
ADDRESS
TIME
EUNS
95 Jalan Eunos S (419529)
2.30pm - 4.00pm
EUNS
95 Jalan Eunos S (419529)
2.30pm - 4.00pm
CENTRE
CODE
ADDRESS
TIME
7
Jiemin Primary School
JMPS
2 Yishun Street 71 S(768515)
10.00am - 1.15pm
8
St Anthony Primary
School*
SAPS
1 Bukit Batok Street 34 S(659321)
8.30am - 11.45am
9
Xingnan Primary School*
XNPS
5 Jurong West Street 91 S(649036)
9.00am - 12.15pm
SLSS
11 Marsiling Lane S(739148)
9.00am - 12.15pm
JVSS
202 Jurong East Avenue 1 S(609790)
9.00am - 12.15pm
BMSS
10 Lengkok Bahru, S(159050)
9.00am - 12.15pm
RGSS
50 Choa Chu Kang North 5 S(689621)
9.00am - 12.15pm
10
11
12
13
S/NO
14
S/NO
15
Si Ling Secondary
School*
Jurongville Secondary
School*
Bukit Merah Secondary
School
(For upper secondary)
Regent Secondary
School*
CENTRE
Wed (Maths)
Teck Ghee Primary
School*
(For Pri 2 & 3 only)
CENTRE
Wed (Sci), Sat
(English/Maths)
Corporation Primary
School
OTHER CENTRES
1
2
3
4
5
6
7
CENTRE
CODE
TGPS
CENTRE
CODE
CRPS
CENTRE
CODE
ADDRESS
TIME
1 Ang Mo Kio Street 32 S(569299)
2.15pm - 3.45pm
ADDRESS
TIME
31 Jurong West Street 24 S(648347)
ADDRESS
Henderson Community
HDCC
Blk 93 Henderson Road, #01-212 S(150093)
Centre
Kaki Bukit Community
KBCC
670 Bedok North Road Street 3 S(469627)
Centre
Kolam Ayer Community
KACC
3188 Geylang Bahru S(339717)
Centre
Leng Kee Community
LKCC
400 Lengkok Bahru S(159049)
Centre
Toa Payoh East Student
TPES
Blk 47 Toa Payoh Lor 6 #01-132 S(310047)
Care
Siglap Community Centre
SICC
300 Bedok South Ave 3 S(469299)
(Limited vacancy)
Jalan Kukoh RC
JKRC
Jalan Kukoh Blk 8 #04-37 S(162008)
(Limited Vacancy)
* open for students of that school only
Please refer to the respective CCs for tuition days and time.
Wed: 2.15pm - 3.45pm
Sat: 9.00am - 12.15pm
DATA PRIVACY NOTICE
Personal Data Protection Act was enforced on 2nd July 2014. The PDPA governs the
collection, use and disclosure of individuals’ personal data by organisations in a manner that
recognises both the right of individuals to protect their personal data and the need of
organisations to collect, use and disclose personal data for purposes that a reasonable
person would consider appropriate in the circumstance. Please read this notice carefully
and sign at the bottom of this page. We would not be able to proceed with the
application for tuition if this form is not signed. Thank you.
Data Protection Act
1. Yayasan MENDAKI is an organization that respects
privacy. In the application form, we have requested for your
personal information* (and your family members’ personal
information where applicable).
2. To enable us to assist you effectively, your personal
information may be collected, used or disclosed for the
following purposes:
a. evaluating your application;
b. verifying background information;
c. general administration in providing our services or
assistance;
d. monitoring of performance and compliance with terms
of our services or assistance;
e. offering other assistance provided by Yayasan
MENDAKI;
f. research and analysis for social assistance objectives;
g. reviewing our policies for our services and assistance
programmes; and
h. any other purpose reasonable in connection with the
above.
3. We may disclose your personal information to our
related entities and affiliates (e.g MENDAKI SENSE Pte
Ltd, MENDAKI Club, Community Leaders Forum (CLF))
or other third party service providers for the purposes
stated above. We will require these related entities,
affiliates and third party service providers to assure us
that they will act in compliance with their personal data
obligations and keep your personal information
confidential.
4. If you have provided your family members’ personal
information, you confirm that they have been informed
of the contents of this notice and have consented to the
collection, use or disclosure of their personal
information for the purposes stated in this notice.
5. Do let us know if there are changes to the personal
information you have provided so that we can update
our records accordingly.
6. We will adopt appropriate security safeguards and
measures to protect your personal information from
unauthorized access, collection, use, disclosure,
copying, modification disposal or other risks.
7. The terms of this notice shall be in addition to all other
terms of the service or assistance that may be
applicable to you.
8. You may also find more information about Yayasan
MENDAKI’s personal data protection policy at
http://www.mendaki.org.sg.
Declaration
I d e c l a r e t h a t a l l i n f o r m a t i o n g i ve n h e r e i n
and all attachments hereto are true and
c o r r e c t t o t h e b e s t o f m y k n o w l e d g e . I h a ve
not willfull y suppressed an y information. I
understand that a misrepresentation or
omission of facts will be sufficient cause
for
my
application
to
be
rejected.
Submission of incomplete application forms
will not be processed. The management's
decision is final.
1. I hereby authorise the Ministry of Education
and other relevant organisations to release
information on my child/ ward to Yayasan
MENDAKI for the purpose of monitoring and
evaluating my child’s/ ward’s performance.
2. I understand that no refund will be made if
my child/ ward withdrew after receiving the
notification letter. I also understand that a
class will only be formed if there is a
minimum of 6 registered students.
3. I authorize MENDAKI to take picture and
video recordings of my child/ward during
MTS activities. I understand that these will
be used solely for publicity campaign or a
study if need be.
4. I understand that my child will be removed
from the programme if my child/ward missed
6 lessons consecutively without valid reason.
5. While Yayasan MENDAKI shall take all the
necessary measures that are reasonably
foreseeable to ensure the safety and well being of my child/ ward during all tuition
sessions conducted at the designated
centre, I agree not to hold Yayasan
MENDAKI liable for any personal injury to, or
accident or harm, fatal or otherwise
sustained by my child/ ward during or after
the sessions.
6. I have read and understood the above
clauses and agree to abide by the rules and
regulations of MENDAKI Tuition Scheme as
stipulated in the Students’ Guide. This
authorisation will be in force until it is
revoked by me in writing.
I agree to the contents of this notice and consent to the collection, use and disclosure of personal information as set forth in the
notice.
* If you are filling up this application form for your child/ward, all references to “your personal information” here shall refer to your
child’s/ward’s personal information”. Accordingly, any reference to “your family members’ personal information” shall refer to your
child’s/ward’s family members’ personal information.
Name of Client
:
NRIC of Client
:
Signature of Client/
:
Date
Pg 1 out of 6
NOTIS PRIVASI DATA
Akta Perlindungan Data Peribadi telah dikuatkuasakan pada 2 Julai 2014. Notis ini mengawal
pengumpulan, penggunaan dan pendedahan data peribadi individu oleh persatuan dengan cara
yang mengiktiraf kedua-dua hak individu untuk melindungi data peribadi mereka dan keperluan
persatuan untuk mengumpul, menggunakan dan mendedahkan data peribadi untuk tujuan yang
bersesuaian dengan keadaan. Sila baca notis ini dengan teliti dan tandatangan di bahagian
bawah halaman ini. Kami tidak dapat meneruskan permohonan untuk tuisyen jika borang ini
tidak ditandatangani. Terima kasih.
1.
2.
Akta Perlindungan Data
Yayasan MENDAKI ialah sebuah pertubuhan yang menghormati privasi. Di
dalam borang permohonan, kami telah meminta maklumat peribadi anda*
(dan maklumat peribadi ahli keluarga anda di mana berkenaan).
Untuk membolehkan kami membantu anda secara berkesan, maklumat
peribadi anda mungkin dikumpulkan, digunakan atau didedahkan bagi
tujuan-tujuan yang seperti berikut:
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
3.
4.
menilai permohonan anda;
mengesahkan maklumat latar-belakang;
pentadbiran umum bagi menyediakan khidmat-khidmat atau bantuan
kami;
pemantauan perlaksanaan dan pematuhan syarat-syarat khidmat atau
bantuan kami;
tawaran lain-lain bantuan yang disediakan oleh Yayasan MENDAKI;
kajian dan analisis bagi tujuan-tujuan bantuan sosial;
penyemakan semula dasar-dasar tentang program-program khidmat
dan bantuan kami; dan
mana-mana tujuan lain yang munasabah berkaitan dengan yang di
atas.
Kami mungkin mendedahkan maklumat peribadi anda kepada entiti-entiti
dan badan kerabat kami yang berkaitan (contohnya MENDAKI SENSE Pte
Ltd, Kelab MENDAKI, Forum Pemimpin Masyarakat (CLF)) atau penyediapenyedia khidmat pihak ketiga yang lain bagi tujuan-tujuan yang dinyatakan
di atas. Kami akan memerlukan entiti-entiti, badan-badan kerabat dan
penyedia-penyedia khidmat pihak ketiga yang berkaitan ini memberi kami
jaminan bahawa mereka akan bertindak dengan mematuhi obligasi-obligasi
data peribadi mereka dan menyimpan maklumat peribadi anda sebagai
rahsia.
Jika anda telah memberi maklumat peribadi ahli keluarga anda, anda
sahkan bahawa mereka telah diberitahui tentang kandungan notis ini dan
telah mengizinkan pengumpulan, penggunaan atau pendedahan maklumat
peribadi mereka bagi tujuan-tujuan yang dinyatakan di dalam notis ini.
5.
Harap beritahu kami jika terdapat perubahan pada maklumat peribadi yang
anda telah berikan supaya kami dapat mengemaskinikan rekod-rekod kami
dengan sepatutnya.
6.
Kami akan mengambil langkah-langkah dan pelindung-pelindung
keselamatan yang sesuai untuk melindungi maklumat peribadi anda
daripada akses, pengumpulan, penggunaan, pendedahan, penyalinan,
pemindaan, pelupusan atau risiko-risiko lain tanpa izin.
7.
Syarat-syarat notis ini akan menjadi tambahan kepada syarat-syarat lain
mengenai khidmat atau bantuan yang mungkin berkenaan dengan anda.
8.
Anda boleh juga mendapatkan lebih maklumat tentang dasar perlindungan
data peribadi Yayasan MENDAKI di http://www.mendaki.org.sg.
Pengisytiharan
S a y a m e n g a k u s e s u n g g u h n y a s e m u a k e te r a n g a n
y a n g d i b e r i k a n d i a ta s a d a l a h b e tu l d a n t e p a t. S a y a
ti d a k
menyembunyikan
sebarang
keterangan
p e n t i n g u n tu k m e n d a p a t k a n b a n tu a n i n i . S a y a
fa h a m j i k a s a y a m e m b e r i k a n k e t e r a n g a n p a l s u ,
p e r m o h o n a n s a y a u n tu k m e n d a p a t k a n b a n tu a n i n i
a k a n d i to l a k . Bo r a n g y a n g ti d a k l e n g k a p ti d a k a k a n
d i p r o s e s . Ke p u tu s a n p i h a k p e n g u r u s a n a d a l a h
muktamad.
1.
Di sini saya mengizinkan Kementerian Pendidikan
dan badan-badan lain untuk memberi maklumat
mengenai anak/ waris saya kepada Yayasan
MENDAKI untuk tujuan pemantauan dan penilaian
prestasi anak/ waris saya.
2.
Saya sedia maklum bahawa yuran tuisyen tidak akan
dikembalikan sekiranya anak/ waris saya ingin
mengundurkan
diri setelah
menerima
surat
pemberitahuan. Saya juga sedia maklum bahawa
kelas tuisyen hanya akan bermula jika ada 6 pelajar
atau lebih yang mendaftar untuk kelas tersebut.
3.
Saya membenarkan MENDAKI untuk mengambil
gambar atau video rakam anak / waris saya semasa
aktiviti MTS. Saya faham bahawa ini akan digunakan
semata-mata untuk kempen publisiti atau kajian jika
perlu.
4.
Saya sedia maklum bahawa anak saya akan
diberhentikan daripada program ini jika dia tidak
hadir pada 6 sesi berturut-turut tanpa sebarang
sebab yang munasabah.
5.
Saya maklum bahawa Yayasan MENDAKI akan
mengambil langkah-langkah yang perlu untuk
memastikan keselamatan anak/ waris saya ketika
menghadiri kelas tuisyen MENDAKI, dan saya tidak
akan mempertanggungjawabkan Yayasan MENDAKI
sekiranya anak/ waris saya cedera atau ditimpa
kemalangan ketika atau sesudah kelas.
6.
Saya sudah membaca dan memahami keterangan di
atas dan bersedia mematuhi syarat-syarat Kelas
Tuisyen MENDAKI seperti yang tertera di dalam Buku
Panduan pelajar. Pengakuan ini berkuatkuasa
sehingga ia dimansuhkan oleh saya dalam penulisan.
Saya bersutuju dengan kandungan notis ini dan mengizinkan pengumpulan, penggunaan dan pendedahan maklumat peribadi yang
dinyatakan di dalam notis ini.
* Jika anda mengisi boring permohonan ini untuk anak/jagaan anda, semua rujukan mengenai “maklumat peribadi anda” di sini akan
merujuk kepada maklumat peribadi anak/jagaan anda. Dengan itu, sebarang rujukan mengenai “maklumat peribadi ahli keluarga anda”
akan merujuk kepada maklumat peribadi ahli keluarga anak/jagaan anda.
Nama Klien:
K/P Klien :
Tandatangan
:
Klien/Tarikh
Pg 2 out of 6
SECTION 1: INFORMATION ON HOUSEHOLD MEMBERS AND INCOME
1. MAIN PARENT/ GUARDIAN’S PARTICULARS
*Main parent must be a Singaporean or Permanent Resident.
NAME (as in NRIC)
NRIC No
Date of Birth
Nationality
 Singaporean  Permanent Resident
Role in Family
 Father  Mother  Guardian
 Others: _________________ (pls specify)
Marital Status
Gender
 Married  Single  Divorced Others
 Male  Female
Religion
Race
 Islam Others
 Malay  Chinese  Indian  Others
Type of Residence
Ownership of Residence
1-room
5-room
 Others
 2-room
 3-room  4-rooms
 Executive/ Maisonette  Landed
 Owned
 Rented  Others
Address
Residential Number
Mobile Number
Email Address
Current Occupation
Company
Total Net Monthly Income (please refer to pg 4)
2. DECLARATION (FOR UNEMPLOYED,CASUAL&PART TIME WORKERS)
I, Name:__________________________________________________________NRIC/Passport:_____________
Address:____________________________________________________________________________________
declare that I am currently not working / working as a /an __________________________________________
(occupation) at __________________________________________ (company / agency) since _____________
My monthly income is $________________.
I, undersigned, declare that all the above to be true and correct. I understand that providing any false information is an
offense under section 182 of the Penal Code (Chapter 24), punishable by a fine of $1,000 or a term of imprisonment of up
to 6 months or both. I further understand that if I furnished any false information, Yayasan Mendaki will recover from me
all monies paid to me under the Collaborative Tuition Programme.
_________________________
_____________________
Signature
Date
Pg 3 out of 6
3. PARTICULARS OF HOUSEHOLD MEMBERS
Name (as in BC or NRIC)
Nationality
BC/NRIC
Date of
Birth
Role in
Family
Gender
Religion
Race
Employment Status
 Father
 Employed
 Mother
 Housewife
 Malay
 Guardian
 Student (Pri/Sec)
 Male
 Islam
 Chinese
 Child
 Students (Pre-School)
 Female
Others
 Indian
 Ward
 Student (Tertiary)
 Others
 Others:
 Unemployed
__________
 Others
 Father
 Employed
 Mother
 Housewife
 Singaporean
 Malay
 Guardian
 Student (Pri/Sec)
 Permanent
 Male
 Islam
 Chinese
 Child
 Students (Pre-School)
Resident
 Female
Others
 Indian
 Ward
 Student (Tertiary)
 Foreigner
 Others
 Others:
 Unemployed
__________
 Others
 Father
 Employed
 Mother
 Housewife
 Singaporean
 Malay
 Guardian
 Student (Pri/Sec)
 Permanent
 Male
 Islam
 Chinese
 Students (Pre-School)
 Child
Resident
 Female
Others
 Indian
 Ward
 Student (Tertiary)
 Foreigner
 Others
 Others:
 Unemployed
__________
 Others
 Father
 Employed
 Mother
 Housewife
 Singaporean
 Malay
 Guardian
 Student (Pri/Sec)
 Permanent
 Male
 Islam
 Chinese
 Child
 Students (Pre-School)
Resident
 Female
Others
 Indian
 Ward
 Student (Tertiary)
 Foreigner
 Others
 Others:
 Unemployed
__________
 Others
 Father
 Employed
 Mother
 Housewife
 Singaporean
 Malay
 Guardian
 Student (Pri/Sec)
 Permanent
 Male
 Islam
 Chinese
 Child
 Students (Pre-School)
Resident
 Female
Others
 Indian
 Ward
 Student (Tertiary)
 Foreigner
 Others
 Others:
 Unemployed
__________
 Others
 Father
 Employed
 Mother
 Housewife
 Singaporean
 Malay
 Guardian
 Student (Pri/Sec)
 Permanent
 Male
 Islam
 Chinese
 Child
 Students (Pre-School)
Resident
 Female
Others
 Indian
 Ward
 Student (Tertiary)
 Foreigner
 Others
 Others:
 Unemployed
__________
 Others
*Gross Monthly Income: It refers to gross monthly wages or salaries before deduction of employee CPF contributions and personal income tax. It comprises basic wages, overtime pay,
commissions, tips, other allowances and one-twelfth of annual bonuses.
**Net Monthly Income: It refers to basic salary, less of CPF deduction.
Current
Occupation
and
Company
School, Level
and Stream
(2014)
*Gross
Monthly
Income
**Net
Monthly
Income
 Singaporean
 Permanent
Resident
 Foreigner
TOTAL:
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Please tick (  ) where applicable in the circles/boxes
Applying for tuition at:
MENDAKI
CDAC
SINDA
EA
SECTION 2: STUDENT’S PARTICULARS
ADDITIONAL PARTICULARS
Name
OTHERS
BC or NRIC No
School Name (2014)
SA2 Results in 2014
Subjects
English
Marks
Grades/Band
Mathematics/ Elementary Mathematics
Science/ Combined Science (Phy/Chem)
School in 2015
Level in 2015
Stream in 2015
Choice of centre in 2015 (Please refer to Centre
Listing and fill in the codes)
 Standard
 Foundation
Choice 1 __ __ __ __
Choice 2 __ __ __ __
Tuition Subjects in 2015 (Please tick)
 P1 P2  P3
Subject(s)
English
Maths
 P4
 P5
 P6
Maths :  Standard  Foundation
English :  Standard  Foundation
Science :  Standard  Foundation
S1E
S2E
S3E S4E
S1NA S2NA S3NA S4NA S5NA
S1NT S2NT S3NT S4NT
Subjects: English Maths Combined Science**
**Combined Science only for Physics and Chemistry.
Mode of Payment
 Cash  GIRO Cheque  Money Order  Postal Order  Applying for ETF / Fee waiver
Cheque No /Money Order No / Postal Order No
GIRO Standing Order Form verified and submitted?
 Yes
 No
For GIRO payment, please fill in the new
POSBank GIRO Standing Order form.
SECTION 3: CHECKLIST – SUPPORTING DOCUMENTS TO BE SUBMITTED WITH THIS FORM
Please tick in the checklist the documents that have been attached to this application form. Incomplete application form or application with missing
supporting documents will not be processed.
For CTP only
For CTP & ETF
1. Copy of student’s examination results (SA1 and SA2) 2014
1. Copy of all students’ examination results (SA1 and SA2)
2014
2. Copy of student’s birth certificate or NRIC
2. Copy of all students’ birth certificates or NRICs
3. Copy of parent/guardian’s NRIC
* If you would like to register for more than one child, please
attach additional Section 2 form(s) with your other
child/children’s details.
3. Copy of parents and all family member’s (staying in the
same household) NRIC
4. Copy of latest payslip/Letter from employer confirming latest
pay/Income tax return/CPF statement of all working family
members
5. Copy of Latest CPF Contribution History AND Income
Declaration of ALL Non-Working adults in the household
6. Retrenchment letter (if applicable)
7. Marriage / Divorce / Death Certificate (whichever is
applicable)
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SECTION 5: FOR OFFICIAL USE ONLY
Name of Officer attending to case: ___________________ ______________________
Date of form received: ___________________________________________________
Net Monthly Household Income (A):
_______________________________________
Number of family members living in the same house / flat (B): ____________ _______
Per Capita Income (A)/(B): ________________________________________________
Application Result: Recommended /Not Recommended
Checked by/Date: _______________________________________________________
Recommendation is: Approved / Not Approved *
Verified By: ____________________________________________________________
Signature of Officer/ Date: ________________________________________________
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