THEKCHEN CHOLING (SINGAPORE) EDUCATION BURSARY AWARD 2016 APPLICATION FORM

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THEKCHEN CHOLING (SINGAPORE) EDUCATION BURSARY AWARD 2016 1 x Passport Size Photo APPLICATION FORM Part 1 : Particulars of Applicant (Student) Name of Student NRIC/Birth Cert. No. : *Mr/Ms : Date of Birth: Gender : *Male / Female Name of Present School : Class Level (in 2015): (*Pri/Sec/JC/Tertiary): Home Telephone : Hand Phone : Race: Home Address : *Please delete where appropriate. Part 2 : Particulars of Guardian/Parent Name of Guardian/Parent (as in NRIC/ Passport) *Mr/Mrs/Mdm/Ms : NRIC/Passport No. : Relationship to Student : Hand Phone : Office Number : Email : Part 3: Information on Family Members Total No. of Household Members: Total No. of School-going Children: NAME NRIC/Birth Cert. No Date of Birth Relationship Education Occupation Gross monthly income Are there any members in your family who are: Disabled or Chronically sick? If yes, please state relationship and illness:

Part 4: Information on Household *Type of Dwelling: (Rental/ Purchased) HDB 1-room HDB 2-room HDB 3-room HDB 4-room HDB 5-room HDB Executive Flat HUDC/ Private Apt Others, please specify Part 5: Information on Current Assistance Given by Other Agencies Is the household receiving any form of social assistance from other organisations: YES / NO Name of Organisation Status of Application Amount Part 6: Information on other Scholarship/Merit/Bursary Award Are you currently applying for any other education Scholarship/Merit/Bursary Award from other organization? YES / NO If YES, please specify: Organization Type of Award Successful (Yes / No) Part 7: Declaration I declare that all the information herein and all attachments are true and accurate to the best of my knowledge. I also confirm that my household members are aware of and have agreed to provide with the abovementioned information. I am also aware that any false information provided will result in the bursary being rejected. Signature of Parent / Guardian Date List of documents required: a) Photocopy of Birth Certificate/ Passport of Child applying for bursary b) Passport size photograph of student applying for bursary c) Photocopy of NRICs of both parents d) Photocopy of latest pay-slip, income tax assessment returns or letter from employer declaring income status of all adults in the same household e) Certified copy of latest school examination results f) Student certification form from the respective educational institution g) Relevant documents to support the application Closing Date: 31 Jan 2016 (Sun) 6pm FOR OFFICIAL USE : Date of registration: Checked & Received by: Submission Approval:

THEKCHEN CHOLING (SINGAPORE) EDUCATION BURSARY AWARD 2016 Established in 2010, the Education Bursary Award is to provide financial assistance to students from low-income families to continue their education and for our members of Thekchen Choling or children of members to assist them to excel in their academic pursue. This Education Bursary Award is open to Singapore citizens regardless of race or religion, studying in government institutions. There are three categories of the Awards, namely the Primary, Secondary and Tertiary Category. Eligibility Criteria Applicants must meet the following eligibility criteria: 1. Applicant must be a Singapore Citizen 2. Applicant must be full-time students studying in local government institutions from Primary 1 to Tertiary 3. Total gross monthly household income must not exceed $2500; OR 4. Per capita income of not more than $600**; and 5. Applicant must have good conduct and satisfactory academic performance 6. Only 1 applicant per household can apply. (*Total amount of gross income of all the working people in the same Household. **Per Capita Income= Gross family income/ total no. of family members living together with student) Value of Award 1. Primary: $200 each 2. Secondary/ JC: $300 each 3. Tertiary (Poly/ University): $400 each

Application Procedure 1. Application forms are available at front desk counter. Click here to download the application form from the website. 2. Please write clearly and legibly on the application form. 3. All parts of the forms must be filled in. Write Nil or N.A. where applicable. 4. Interested applicants to submit the following supporting documents: a) Photocopy of Birth Certificate/ Passport of Child applying for bursary b) Passport size photograph of student applying for bursary c) Photocopy of NRICs of both parents d) Photocopy of latest pay-slip, income tax assessment returns or letter from employer declaring income status of all adults in the same household e) Certified copy of latest school examination results f) Student certification form from the respective educational institution g) relevant documents to support the application 5. Students NOT eligible: - Students who are in kindergarten 2 (K2) in 2015 - Students from private institutions 6. Please send the completed application form and all supporting documents to: The Education Bursary Award Committee Thekchen Choling (Singapore) 2 Beatty Lane Singapore 209945 Closing date of application All applications must reach the temple by 31 Jan 2016 (Sunday) 6PM. Late or incomplete submission of applications will not be considered. Notification of Results All decision made are final. The Management committee of the temple reserves the right to give out bursaries to the most deserving students. Only Successful applicants will be notified by mail. Successful applicants will be invited for the Award Presentation Ceremony on Vesak Day on 21 May 2015 (Sat).

STUDENT CERTIFICATION FORM (Applicant should approach school administration to fill up this form.) To: Education Bursary Award Committee Thekchen Choling (Singapore) 2 Beatty Lane Singapore 209945 Re: Certification of Student This is to certify that (Name of student), NRIC No. is a student of our institution for Year 2016. Signature of Principal Date Name of Principal: Institution/ School : Institution/ School Stamp: