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APPLICATION FOR SINGAPORE CHILDREN'S SOCIETY RESEARCH GRANT

1. Personal Particulars :

Name :

Gender :

Male Female

Permanent Address:

Postal Address :

Tel :

(O)
(H)
(Pager / Mobile)

Email :

Date of Birth :	Place of Birth :


Country of Residence :


Marital Status :	No. of children :


NRIC/Passport No. :

Date & place of issue :

Type of NRIC :

Singapore pink	Singapore blue	Malaysian pink
Malaysian blue	N.A.

Citizenship (Please attach a certified true copy of your birth certificate or citizenship certificate. Singapore PRs should attach documentary proof of their status.)

Singaporean	Singapore Permanent Resident
Malaysian	Others (please specify):

2. Particulars Of Next Of Kin

Name :

Relationship :

Occupation :

Permanent Address:

Telephone :

(O)
(H)
(Pager / Mobile)

3. Proposed Research

Proposed topic of research (Please attach a copy of your detailed Research Proposal, including estimated costs.)

Significance and aims of research project

4. Present Place And Course Of Study

5. Academic Qualifications

State your post-secondary and tertiary education. Please attach certified true copies of the relevant certificates.

From	To	Name Of Institution	Qualification Obtained	Year Obtained

Research Experience

Scholarships, prizes, other awards, memberships in academic and professional societies (List in chronological order and please attach documentary evidence.)

6. Languages

Written and Spoken
Spoken only
Written only

7. Have you been awarded or are currently in receipt of any similar or equivalent scholarship, fellowship or award? If so, please state the name of the scholarship, fellowship or award and duration.


Yes	No

Please provide details:

8. Are you bonded to any organisation?


Yes	No

If so, please specify the name of the organisation and state the length of bond to be Served.

9. Declaration

Should my application be successful, I undertake not to accept any similar or equivalent grants/awards from other organisations. I will withdraw my application from Singapore Children's Society should I accept other similar or equivalent grans/awards from other organisations. I certify that all statements made by me on this form are correct. I understand that withholding informaton requested in this application or giving inaccurate or false information will render this application invalid.


Date: _________________	Signature: __________________

*Important: Selection of successful applicants will be carried out by a panel. Kindly note that the decision by the panel is final. No subsequent changes or appeals by applicants will be entertained.

Please send your application to:
Singapore Children's Society
Research & Outreach Department
Blk 107 Yishun Ring Road
#01-233
Singapore 760107