2014 DR GOH KENG SWEE (GKS

INSTRUCTIONS TO APPL

1. There are 3 parts in this application you must complete Form, Essay and Declaration & Survey. All parts mu
Please be reminded that you must select the "Yes, I agree" option, to agree to the clause under Declaratio

2. Please note the following, in completing your application form:

Yellow fields are compulsory and must be completed. Indicate 'Nil' if fields are not applicable.
Blue fields should be entered if the relevant information is available. Please refer to the tab Sample Form w
Fields marked with a red triangle in the top right corner contains help text. Hover your mouse cursor over th
Do not add, delete or format any cells in the application form.
3. Email completed applications (Form, Essay and Declaration & Survey) to applications@psd.gov.sg, by
19 February 2014. Incomplete applications and applications received after this date will not be considered.

4. Photocopies of your birth certificate/passport and educational certificates must be produced for verification pu

5. You should concurrently apply for admission into Singapore universities and adhere to the universitys admissi
6. Please note that shortlisted candidates will have to attend an interview in Singapore in mid May 2014.

Personal and Family Particulars

Academic Results

Prizes / Awards / Co-Curricular Activities

Notable Achievements

Subject

Grade

Family Background
Father

Mother

Siblings
Select an option

Select an option

Select an option

Select an option

Are the above results your final results?

If "No", please indicate expected date of
receiving your final results:

Select an option

SAT Scores
(1) Scholastic Assessment Test I
Critical Reading
Math
Writing
Note: If your SAT I scores are not available yet, or if you are
expecting a new set of results, you may update us via email
by 1 March 2014.

Score

(2) Scholastic Assessment Test II

Currently studying in SG under a scholarship?

Select an option

Additional information

Select an option

MMYYYY
National
Percentile

Year

Other Information
Application for University Admission
Singapore Universities
1st choice
Select an option
Option
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2nd choice
Select an option
Option
Select an option
3rd choice
Select an option
Option
Select an option
4th choice
Select an option
Option
Select an option
5th choice
Select an option
Option
Select an option
Overseas Universities
Option
Select an option

Option
Select an option

Option
Select an option
Application for Other Scholarship(s)
Select an option
Select an option

Select an option
Select an option

Select an option
Select an option

In the yellow field below in no more than 500 words, describe an experience or incident that has shaped your values.
How did this experience or incident affect you? How did you change as a result of this experience or incident?
(Press Alt+Enter to move to a new line within the field.)
Sample Text

Do you hold any citizenship, other than the one entered in the "Form" section?

Select an option

Do you hold Permanent Residence Status of any other country?

Select an option

Have you ever suffered, or are you suffering from any physical impairment, disease or mental illness?

Select an option

Have you ever been convicted in a court of law in any country?

Select an option

Have you previously applied for the Dr. Goh Keng Swee Scholarships?

Select an option

Have you studied in Singapore before?

Select an option

By submitting this form to PSC, I declare that the information provided in this application is correct.
I declare that the information in all parts of this form are true to the best of my knowledge, and I have not wilfully suppressed any material facts.
I understand that any provision of inaccurate or false information or omission of information will render my application invalid and that, if admitted on the basis of such
information, I will be required to withdraw from the scholarship.
Select an option

Survey
Thank you for you interest in the Dr Goh Keng Swee scholarship.
To help us in our review and publicity efforts, please let us know where you have obtained information on the Dr Goh Keng Swee Scholarships

Please let us know if you have any other feedback or comments on the application exercise below.

Form

All Yellow Fields are compulsory

Personal and Family Particulars

Academic Results

Alyssa Kristiano
9/14/1993
Indonesia Citizen
123456789X

Excelpro High School

Surat Tamat Sekolah Menengah Umum Tingkat Atas
Subject
English
Indonesian Language
Mathematics
Physics
Chemistry
History
Sociology
Arts

Family Background
Father
Arthur Kristiano
Indonesia Citizen
Author
N.A.

Prizes / Awards / Co-Curricular Activities

2007-2012
2012
Grade
A
A
B
A
A
B
B
C

Mother
Athena Wijaja
Indonesia Citizen
Homemaker
N.A.
Siblings
Alexander Kristiano
Brother
Indonesia Citizen
Student
Excelpro High School
Amelia Kristiano
Sister
Indonesia Citizen
Student
Excelpro High School
Angelina Kristiano
Sister
Indonesia Citizen
Student
Glory Junior School
Angelina Kristiano
Sister
Indonesia Citizen
Student

Are the above results your final results?

If "No", please indicate expected date of
receiving your final results:

SAT Scores
(1) Scholastic Assessment Test I
Critical Reading
Math
Writing
Note: If your SAT I scores are not available yet, or you are
expecting a new set of results, you may update us via email
by 1 March 2014.
(2) Scholastic Assessment Test II

No
03/2013

Score

National
Percentile

740
690
760

86
79
89

Notable Achievements
National Mathematics Challenge 2009 Runner-up
Excelpro High School Nature Appreciation Club President
Co-organised Project Samaritan (an event to distribute
collected donations to the homeless)
Volunteer of the Month - nominated for community service
contributions at Milendra Family Service Centre

Year
2010
2011-2012
2011
Dec 2011

Blue Fields are to be filled if

info is available
Other Information
Application for University Admission
Singapore Universities
1st choice
National University of Singapore
Business Administration
Pending University's Reply
2nd choice
Nanyang Technological University
Business
Pending University's Reply
3rd choice
Singapore Management University
Engineering and Management Science
Pending University's Reply
4th choice

5th choice

Overseas Universities

Application for Other Scholarship

National University of Singapore
Local Scholarship
Business Administration
Pending Organisation's Reply

Double Degree

Do you hold any citizenship, other than the one entered in the "Form" section?

No

Do you hold Permanent Residence Status of any other country?

No

Have you ever suffered, or are you suffering from any physical impairment, disease or mental illness?

No

Have you ever been convicted in a court of law in any country?

No

Have you previously applied for the Dr. Goh Keng Swee Scholarships?

No

Have you studied in Singapore before?

Yes

2002 - 2003, Anglo Chinese School (Junior),

By submitting this form to PSC, I declare that the information provided in this application is correct.
I declare that the information in all parts of this form are true to the best of my knowledge, and I have not wilfully suppressed any material facts.
I understand that any provision of inaccurate or false information or omission of information will render my application invalid and that, if admitted on the basis of such
information, I will be required to withdraw from the scholarship.
Yes, I agree.

Survey
Thank you for you interest in the Dr Goh Keng Swee scholarship.
To help us in our review and publicity efforts, please let us know where you have obtained information on the Dr Goh Keng Swee Scholarships

I heard about the scholarships from my school senior and googled for the Dr. Goh Keng Swee scholarship website.

Please let us know if you have any other feedback or comments on the application exercise below.

None. Thank you.