附件2 申请表1.docx

NANYANG TECHNOLOGICAL UNIVERSITY (NTU) NATIONAL INSTITUTE OF EDUCATION (NIE) APPLICATION FOR ADMISSION TO THE MASTER OF ARTS (APPLIED LINGUISTICS) WITH MOE SCHOLARSHIP INSTRUCTIONS TO APPLICANTS 1. This CHECKLIST is to be submitted as the COVER PAGE of your application. 2. All sections of the application form must be completed. If any section does not apply to you, please enter “Nil” or “Not Applicable”. 3. The application form should be typed and returned together with the supporting documents (softcopies) listed below. Except for the passport-sized colour photograph, please note that all documents submitted MUST be in PDF format. Please arrange the application documents in the order below and tick the relevant checkboxes to indicate the documents submitted. Completed Application Form, signed at the AFFIRMATION section. One recent passport-sized colour photograph • File Format: JPEG or JPG (Height and Width must be 400 x 514 pixels) • Image must show the full face and taken within the last 3 months • Photograph must be in colour and taken against a white background with a matt or semi-matt finish. Completed Supplementary Information Form. Passport containing the identification / passport number, name, date of birth, etc. Note: All academic/ degree scrolls & transcripts have to be in their original language. If the original language is not in English, the official translations in English must be attached. Bachelor’s Degree Scroll. Complete transcript for Bachelor’s Degree. If a complete transcript is not available, you must include a complete set of examination results for every semester. Postgraduate Diploma in Education (PGDE) Scroll and/or other equivalent professional certificates. Complete transcript for professional qualifications (including PGDE, Cert Ed, etc). If a complete transcript is not available, you must include a complete set of all the semestral examination results. If the professional qualification does not have a transcript/ examination results, please indicate this on the application. TOEFL / IELTS Score Please note that an incomplete application will not be considered. Please send the application form and supporting documents to nieadmpp@nie.edu.sg. 1 APPLICATION FOR ADMISSION (AUGUST 2021 INTAKE) MASTER OF ARTS (APPLIED LINGUISTICS) WITH MOE SCHOLARSHIP INSTRUCTIONS: Enter information over this symbol » Indicate choices with X in the appropriate area Extra sheets may be used whenever necessary. Complete all sections. (A) PERSONAL PARTICULARS Name (As in Passport) Include title Dr/Mr/Mrs/Mdm/Miss Name in Chinese » » DATE OF BIRTH (day) (month) (year) » » » Passport No. Nationality » » AGE As on January » SEX Male: » Female: » For Non-Singaporeans only: Please indicate ‘Yes’ or ‘No’ in the boxes below Are you a Singapore Permanent Resident? » Are you holding a Singapore Employment Pass / Work Permit? » Are you holding a Singapore Dependant Pass? » If applicable, please give your FIN No. FIN No. » (Please attach a copy of documentary evidence such as a valid re-entry permit / Employment Pass / Work Permit / Dependant Pass) MARITAL STATUS RACE RELIGION EMAIL ADDRESS POSTAL ADDRESS Block No. /House No.: Street Name: Single Married Divorced Widowed » » » » Chinese Malay Indian Other (specify) » » » » » » POSTAL ADDRESS (in Chinese) » Unit No.: Postal Code: Country: CONTACT DETAILS Tel (home) » Tel (office) » Handphone » 2 (B) EDUCATIONAL BACKGROUND (Please attach copies of degree scrolls, professional certificates (eg. PGDE, Dip Ed, Cert Ed) and transcripts of university academic records.) University (Undergraduate and Postgraduate) From (mm/yy) » » » » To (mm/yy) » » » » University/Country » » » » Field of Specialisation » » » (Include Honours if applicable) » » » » » » » » Professional Qualifications / Membership From To Professional Board/Country (mm/yy) (mm/yy) » » » Qualification » » » Award/Status » » » Programmes you are currently pursuing (Please list Diploma and above only): Programme Institution Expected Completion Date » » » » » » (C) WORK EXPERIENCE Current Employer: From (mm/yy) Designation » » Company/Organisation Duration » » Address of Current Company/Organisation Block No. /House No.: Street Name: Unit No.: Postal Code: Country: Employment History: (Please list down in chronological order) From To (mm/yy) (mm/yy) Designation Company/Organisation » » » » » » » » » » » » » » » » Duration » » » » Total duration of teaching experience (if applicable) years » months » Total duration of working experience since obtaining Bachelor's degree years » months » 3 (D) DECLARATION OF CRIMINAL RECORDS The University is committed to safeguarding and promoting the welfare of students and employees. In relation thereto, you are required to complete and disclose information on any criminal record that you may have either in Singapore or overseas. All information provided will be treated in the strictest confidence. Please choose one of the options below:  I have NO criminal convictions, reprimands, warnings, police cautions or any pending investigation/prosecution against me in Singapore (including SAF military courts, SPF or SCDF Disciplinary Board) or any other country.  I HAVE one or more of the following criminal records against me such as criminal convictions, reprimands, warnings, police cautions or any pending investigation/prosecution in Singapore (including SAF military courts, SPF or SCDF Disciplinary Board) or any other country. The details are provided below: Criminal Record Cautions/ Reprimands/ Warnings/ Convictions Nature of Name of Court/ Date of criminal record Offence(s) Tribunal/ (DD-MMM-YYYY, Authority eg. 01-JAN-2019) Pending Prosecution(s) or Investigation(s) Details of Alleged Name of Court/ Tribunal/ Offence(s) Authority (if known) 4 Details of Sentence/ Disciplinary Action/ Decision by Authority Date (if known) (DD-MMMYYYY, eg. 01- JAN-2019) (E) OTHER DECLARATION i. Have you previously or are you currently enrolled as a postgraduate student of NTU/ NIE/ NUS/ SMU/ SUTD? Yes/No ii. Yes/No Have you been offered any MOE sponsorship for the programme enrolled? If yes, please provide details: Sponsorship Detail: ______________________________________________________ Status: (Please choose one) Graduated Currently Pursuing Withdrew Refused Re-admission iii. Have you ever suffered or are you suffering from any physical impairment, disease or mental/nervous disorders or have been referred for psychiatric treatment for anxiety, depression, stress, eating disorder, etc.? Yes/No If yes, please provide details: _______________________________________________ _______________________________________________________________________ (F) AFFIRMATION (I) I acknowledge that I have read and understood the NIE’s Privacy Policy indicated at http://www.nie.edu.sg/privacy-policy (II) I acknowledge that I have read and understood the NTU Personal Data Privacy Statement and Consent for Applicants (Please see attached) and I consent to the NTU collecting, using, disclosing and processing my personal data in accordance with the NTU Personal Data Privacy Statement and Consent for Applicants. (III) I certify to the best of my knowledge, the information provided in this form, is true and accurate and that I have not wilfully suppressed any material fact. I understand that if the information provided herein is false, inaccurate, misleading or incomplete in any way, I may be automatically disqualified from admission to the degree programme, or expelled from the programme. I also permit the University to disclose the information provided when making enquires to check the accuracy of the information and the University may contact me to discuss and/ or obtain additional details of the records that I have provided in this declaration. _________________________________ Signature of Applicant _________________________ Date - End of Application – Created: July 2020 5