Management Development Institute of Singapore Pte Ltd ( MDIS Pte Ltd )

Merit Scholarship Application Form

Instructions:
1. Please attach all relevant and certified true copies of certificates, transcripts with the grading system and documentations
with this application and ensure you have read all the details carefully.

2. This application form must be completed either in typescript or black ink for ease of photocopying.

3. All sections of the form must be completed by either ticking in the appropriate boxes or filling up the provided blank
spaces. If there are any sections not applicable to you, please insert ‘NIL’ or ‘NA’.

A. Scholarship
Scholarship applying for:
Diploma/ Advanced Diploma/
Higher Diploma/Graduate Diploma

Undergraduate Programme

Postgraduate Programme

B. Personal Information
Full Name in block letters. Please underline surname / family name Name in Chinese Characters (if applicable)
Mr / Miss / Mdm:

Nationality: Date of Birth:

Singapore Permanent Resident: Yes / No Identity Card / Passport Number:

PR No: Date if Issue: Country of issue:

Gender: Male / Female Marital Status:

Postal Address: Contact Numbers:
Home: Handphone:
Office: Fax:
Email Address: Race:

Are you a current MDIS Student: Yes / No (If Yes, please state Batch Number):

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 C. Diploma/Advanced Diploma/Higher Diploma/Graduate Diploma Scholarship
Academic Qualifications Record
Please indicate details of all previous studies and attach certified true copies of relevant certificates and transcripts with the
grading system.

Highest Academic Name of Educational Year Completed /

Achievement Attained Institution From To Not Completed

Present Course (if applicable): ❑ MDIS (please specify) ❑ Other Institutions (please specify)
Course Name: Expected Completion Date:

D. Undergraduate Scholarship
Academic Qualifications Record
Please indicate details of all previous studies and attach certified true copies of relevant certificates and transcripts with the
grading system.

Highest Academic Name of Educational Year Completed /

Achievement Attained Institution From To Not Completed

Present Course (if applicable): ❑ MDIS (please specify) ❑ Other Institutions (please specify)
Course Name: Expected Completion Date:


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 E. Postgraduate Scholarship
Academic Qualifications Record
Please indicate details of all previous studies and attach certified true copies of relevant certificates and transcripts with the
grading system.

Highest Academic Achievement Year

Attained Completed /
Name of Educational Institution
(state Class of Honours if applicable) From To Not Completed

Present Course (if applicable): ❑ MDIS (please specify) ❑ Other Institutions (please specify)
Course Name: Expected Completion Date:

F. Commendations, Awards and Prizes

Please include details of any previous awards, prizes, or scholarships won. Attach certified true copies of relevant
documentation.

Type Year Achieved Type Year Achieved

Presently, have you been awarded any other scholarship? ❑ Yes ❑ No

If Yes, please indicate:
Name of Scholarship: Estimated Annual Value:


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 G. Extra-Curricular Activities and Interests

Please include details of any extra-curricular activities, interests and membership of professional bodies etc. Attach certified
true copies of relevant documentation

Name of Professional Body / Society Summary of Responsibilities

Position Held Year
/ Club

H. Family Background

Please include the particulars of your immediate family members and if you are married, the particulars of your spouse and
children.

Name of Employer /
Name Relationship Date of Birth Citizenship Occupation Business / School /
Institution Attending


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 I. Employment History (if applicable)

Please fill up the details of your present or previous employment

Employment Summary of Job Reasons for

Name of Employer Date Joined Date Left
Position Responsibilities Leaving

J. Additional Information

Have you ever been convicted in a court of law? ❑ Yes ❑ No

Have you ever been treated for drug and / or alcohol abuse? ❑ Yes ❑ No

Have you any physical impairment and / or medical disability? ❑ Yes ❑ No

Have you ever been dismissed from the services of any previous employer(s)? ❑ Yes ❑ No

Have you ever been declared bankrupt? ❑ Yes ❑ No

If yes to any of the above, please furnish details: ❑ Yes ❑ No


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 K. Declaration

I declare that the information supplied in this scholarship application and the attachments are complete and correct in every
specific area, and that I have not willfully suppressed any material fact.

I authorise MDIS Pte Ltd to conduct background investigation of all statements made within my scholarship application
through attainment from other educational institutions and relevant authorities, at any time, details of my academic record,
examination results, enrolment and bond statuses, for the purpose of consideration of my application.

I agree that these details be made available to the Scholarship Selection Committee and that false information provided or
omission of facts will be sufficient cause for cancellation of consideration or acceptance of this application.

I agree that upon successful attainment of the scholarship, the Scholarship Selection Committee reserves the right to
withdraw my scholarship at any time, should my progress be deemed unsatisfactory.

I authorise MDIS Pte Ltd to recover the full scholarship amount from me, in the event that I withdraw or fail to complete
the course.

I allow MDIS Pte Ltd to use details of my scholarship award for publicity purposes.

I agree that MDIS Pte Ltd reserves the right to amend the terms and conditions of the scholarship award and I will abide
by them.

I agree to complete the relevant application forms as official enrolment into the academic programme, should I wish to
accept the offer of scholarship.

Signature of Applicant: Date:

July 2010 Rev.1

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