SCHOLARSHIP APPLICATION FORM

UWC Singapore | Application page 2

Personal Particulars

Name: ______________________________________________ Gender: _____________

Date of Birth: ______________________ NRIC: ______________________ Nationality: _____________________ (Please indicate if you are a Singapore PR)

Address: _____________________________________________________________________________________________

_____________________________________________________________________________________________

Email: _______________________________________________________________________________________

Phone (Mobile): __________________________ School: ______________________________________________

Family Particulars Please include all immediate family members in your household.

Name and contact number of parent/guardian: _______________________________________________________

Address of parent/guardian (if different from above): _____________________________________________________

_____________________________________________________________________________

Annual family income (Please select only one of the options below):

< S$36,000 $$36,000-S$60,000 S$60,000 - S$150,000 > S$150,000

Please be assured that this information will be kept private and confidential.

No. Name Relationship to Applicant 1.

2.

3.

4.

5.

6.

Photo

SCHOLARSHIP APPLICATION FORM

UWC Singapore | Application page 3

Academic Record

Are you presently holding a scholarship or planning to apply for one? If so, give details.

Present School / Junior College Past Secondary School

Present Academic Subjects (Please enclose a copy of your results slip)

Grade at GCE O-level / Preliminary Exams (Please enclose a copy of your results slip)

SCHOLARSHIP APPLICATION FORM

UWC Singapore | Application page 4

Activities Record

Where applicable, please indicate the level of your involvement and positions of responsibility held.

Uniformed/Youth groups

Clubs/Societies

Artistic/Musical interests

Social/Community work

Which activity has been most meaningful to you and why?

SCHOLARSHIP APPLICATION FORM

UWC Singapore | Application page 5

Miscellaneous Questions

This section is meant to stimulate your thought process, which will help in the development of your response for the essay section. For this reason, we recommend doing this section before the essay. Please limit your responses to 100 words per question.

1. Do you already have a university course or career in mind? If so, give details.

2. Have you travelled abroad before? If so, give details.

3. If you answered yes to the previous question, how has travelling abroad impacted you or your formative growth?

SCHOLARSHIP APPLICATION FORM

UWC Singapore | Application page 6

4. Mention any special interest, hobby or achievement, which you would like the selection panel to know about.

5. In what way do you see yourself as an engine for change?

SCHOLARSHIP APPLICATION FORM

UWC Singapore | Application page 7

Essay

This final component of the application provides an opportunity for you to give us a clearer sense of you as an individual. We encourage you to write about something of direct importance to you.

Please restrict yourself to no more than two (2) sides of 1 sheet of A4-sized paper. The essay can be either handwritten or typewritten.

In your essay, you may choose to answer the following guiding questions:

Is there a particular person or experience that has inspired or influenced you to be who you are today? Why do you want to go to a UWC? What qualities would you be able to contribute to a UWC? What are your plans for the future? How would a UWC education be conducive to or factor into that?

SCHOLARSHIP APPLICATION FORM

UWC Singapore | Application page 8

Parent/guardians Endorsement

I have read the information sheet on the first page and I understand the selection criteria for the UWC scholarship. This application has been made with my full knowledge and approval, and the facts as given in the form are, to the best of my understanding, true and accurate. The selection committee has the right to verify this information.

Name of Parent/Guardian: ___________________________________ Relationship to Applicant: ______________

Signature: _____________________________________________ Date: __________________________________

SCHOLARSHIP APPLICATION FORM

UWC Singapore | Application page 9

Census/Review

The following questions are solely for research purposes and will only be looked at the end of the application process. Although this section will not affect the outcome of your application, we would appreciate your time in responding with detail and honesty.

1. Apart from your first and second languages, what other languages do you speak and write?

2. What is your religion or belief system?

3. What occupation(s) do your parent/guardian(s) hold?

Parent/Guardian 1:

Parent/Guardian 2:

4. Does either of your parent/guardian(s) hold a university degree?

Yes No

5. How did you find out about UWC? (You can tick more than 1 box)

School (Presentations) Centralized Presentations, Programmes / Short-courses Social Media (Facebook, Tumblr, etc.) UWC Singapore Website Posters Word of Mouth Others: ______________________

SCHOLARSHIP APPLICATION FORM

UWC Singapore | Application page 10

6. Have you come across any form of print or published advertising on UWC (Colleges, movement or scholarships)?

Yes (If yes, please ensure you have ticked the appropriate boxes in the previous question accordingly) No

If you selected No, what do you think wouldve been an effective platform to reach out to you or others like yourself?

7. When did you find out about UWC (movement and/or scholarships)?

8. Are you active on Social Media platforms such as Facebook and Tumblr? If so, do you think its an effectivemeans of reaching out to the youth of your generation? If not, what other modes of communication do you use most?

9. State your three most important reasons why you are applying to UWC.

10. State any other options (of educational institutions) that you had to choose from, if any, and explain how UWCcompared to those options.

11. If you were awarded this scholarship, in what way do you see yourself returning to Singapore and giving back tothe National Committee?

Name: Ouch ThengGender: MaleDate of Birth: 20-Feb-1988NRIC: KhmerNationality: KhmerAddress 1: #21, Street 201, Sangkat Phsar Doeum Thkov, Khan Chamka morn, Phnom PenhAddress 2: CambodiaEmail: ouch.theng@hotmail.comPhone Mobile: +85516586376School: NoRow1: 1NameRow1: Chhim OuchRelationship to ApplicantRow1: FatherNoRow2: 2NameRow2: Kann VyRelationship to ApplicantRow2: MotherNoRow3: 3NameRow3: Ouch ThengRelationship to ApplicantRow3: 1th BrotherNoRow4: 4NameRow4: Ouch TheaRelationship to ApplicantRow4: 1th SisterNoRow5: 5NameRow5: Ouch VuthyRelationship to ApplicantRow5: 2th BrotherNoRow6: 6NameRow6: Ouch LengRelationship to ApplicantRow6: 3th BrotherName and contact number of parentguardian: Ouch Thea (Tel: +855973530580Address of parentguardian if different from above 1: Address of parentguardian if different from above 2: Present Academic Subjects Please enclose a copy of your results slipRow1: National University of ManagementGrade at GCE Olevel Preliminary Exams Please enclose a copy of your results slipRow1: Bachelor Degree of Computer SciencePresent Academic Subjects Please enclose a copy of your results slipRow2: Grade at GCE Olevel Preliminary Exams Please enclose a copy of your results slipRow2: Bac II Present Academic Subjects Please enclose a copy of your results slipRow3: Grade at GCE Olevel Preliminary Exams Please enclose a copy of your results slipRow3: DiplomaPresent Academic Subjects Please enclose a copy of your results slipRow4: Grade at GCE Olevel Preliminary Exams Please enclose a copy of your results slipRow4: Chinese Secondary SchoolPresent Academic Subjects Please enclose a copy of your results slipRow5: Grade at GCE Olevel Preliminary Exams Please enclose a copy of your results slipRow5: Present Academic Subjects Please enclose a copy of your results slipRow6: Grade at GCE Olevel Preliminary Exams Please enclose a copy of your results slipRow6: Present Academic Subjects Please enclose a copy of your results slipRow7: Grade at GCE Olevel Preliminary Exams Please enclose a copy of your results slipRow7: Present Academic Subjects Please enclose a copy of your results slipRow8: Grade at GCE Olevel Preliminary Exams Please enclose a copy of your results slipRow8: Present Academic Subjects Please enclose a copy of your results slipRow9: Grade at GCE Olevel Preliminary Exams Please enclose a copy of your results slipRow9: Present Academic Subjects Please enclose a copy of your results slipRow10: Grade at GCE Olevel Preliminary Exams Please enclose a copy of your results slipRow10: Name of ParentGuardian: Relationship to Applicant: Date_2: Others: Question 2: 1: I am planning to apply for UWC Singapore Scholarship. I expected to pass this scholarship to continue my education in future. This opportunity is the most wonderful for me to bring my knowledge to develop my country.Check Box 2: YesUniformed/Youth groups: Clubs/Societies: Artistic/Musical Interests: Social/Community Work: Question 3: 1: 4: 1: 2: 3: 4: 5: 6: 1: 2: 31: 32: 6: 7: 8: 9: 10: 11: Check Box32: 3: 1: Off2: Off3: Off0: YesCheck Box35: OffCheck Box36: OffCheck Box37: 0: Off1: Off2: Off3: OffCheck Box38: 0: Off1: Off2: Off3: OffSignature: Button1: