Lampiran 2. Registration Form - Students (With Interview QNS)

Annexe A1- Registration Form for Students
Temasek Foundation International - Science Centre Board STEP STEM

ALIVE! 2019 Registration Form for Students
Organised by: Supported by:
COMPLETE ONE FORM PER STUDENT
Given Name: ____________________________________________________________________
Surname: ____________________________________________________________________
*Gender: F / M
*delete where inapplicable
Age: _______________________________________________________
Date of Birth: ____________________________________________________________________
NRIC/Passport No.: _______________________________________________________________
Contact No.: __________________ (Mobile)
__________________ (Home)
Email: ______________________________________________________________________
Secondary Email: _________________________________________________________________
Mailing Address: ____________________________________________________________________
Mailing City, State, Country: __________________________________________________________
Mailing Zip, Postal Code:______________________________________________________
Name of School/Institution: ______________________________________________
Dietary requirements (eg. Vegetarian, allergy to seafood, etc):

_______________________________________________________________________________
Medical Conditions (if any): ______________________________________________ T-shirt size:
______________________________________________________________
Have you attended any sponsored programme in Singapore before? If yes, please specify (Name of
programme, date, etc):
_______________________________________________________________________________
Page 1 of 8
---------------------------------------------Emergency Contact Information----------------------------------------
Next of Kin Name: ____________________________________________________________
Address: ____________________________________________________________________
Postal Code: ____________________________________________________________________
Primary Phone: _________________________________________________________________
Alternate Phone: ________________________________________________________________
Relationship: ____________________________________________________________________
Country: ____________________________________________________________________
-----------------------------------------------Acknowledgement----------------------------------------------------------
I, [Name of student]_____________________________________, [NRIC/Passport
No.]__________________________ certify that all the information that I have provided is correct.
I also understand and agree to the followings if I am selected for this programme.
1. To submit a proposal (not more than 100 words) that addresses a real-world issue related
to one of the designated 5 SDGs faced bymy home country in English as a group.
2. To join the STEP Facebook Group.
3. To read and understand the given reading materials posted in the STEP Facebook Group
before the camp.
4. To share activities daily that I have experienced during and after the camp by posting them
in the STEP Facebook Group.
5. To present a cultural performance during the welcome dinner on 1st day of the camp.
6. To send a post-camp report of spreading STEM mind-set to my fellow students.
7. To do the pre and post survey questions given by the organisers.
8. To allow qualitative and quantitative feedback collection from the organisers.
9. To allow the photos and videos to be taken and used for promotional purposes.
Signature of student: ______________________________
Date: ________________________
Page 2 of 8
Annexe A2- Indemnity Form for Students
Acknowledgement of Risks and Undertaking

I, [Name of student]_____________________________________, [NRIC/Passport
No.]__________________________ am aware that my participation in some of these activities may

involve certain amount of risks (including but not limited to sustaining personal injuries and/or loss
of life should serious accidents occur).
I undertake to always cooperate with the organiser and to diligently comply with all safety and other
instructions whenever I participate in any of these activities. If I have any safety concerns
whatsoever regarding such activities, I shallinform the organiser to have such concerns addressed
prior to my participation.
I hereby irrevocably undertake that I shall not, to the fullest extent permitted by the laws of
Singapore, hold the organisers, or any of its authorised agents responsible forany damage to or loss
of any personal property of personal injury or death (save for personal injury or death resulting from
the negligence of the organiser or any of its authorised agents) that may arise as a result of my
participation in any activity during the camp.
Signature of student: ______________________________
Date: ________________________
NOTE – if you are under 18, you must also provide your parent’s/ guardian’s details and have
him/her sign the declaration below:
Name of *Parent / Guardian:

Postal Address: ________________________________________________________________
Telephone number: ________________________________________________________________
NRIC/ Passport no.: _______________________________________________________________
Declaration by Parent / Guardian:
I agree and consent to my child’s / ward’s participation in all the activities organised in this camp,
being fully aware of the attendant risks involved in such activities.
I hereby irrevocably undertake that I shall not, to the fullest extent permitted by the laws of
Singapore, hold the organisers, or any of its authorised agents responsible for any damage to or loss
of any personal property of personal injury or death (save for personal injury or death resulting from
the negligence of the organiser or any of its authorised agents) that may be sustained by my child’s
Page 3 of 8
/ ward under any of the circumstances set out in my child’s/ ward’s participation in any
activity during the camp.
Signature of Parent / Guardian: ______________________________
Date: ________________________
Page 4 of 8
Annexe A3- Interview Questions for Students
These questions can be used for identifying suitable candidates (to be filled in by
the candidate). Please use additional papers if spaces provided is not sufficient.
1. Why do you think you should be selected for this programme?

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
2. What do you hope to achieve or learn from the camp?

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
3. How do you think this camp can benefit your school after the camp?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
4. What do you want to do after you leave the school?

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
5. What are the leadership roles that you were involved before?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Page 5 of 8
6. What courses/subjects are you currently studying?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Page 6 of 8
Page 6 of 8
Annexe A4- Recommendation by Teachers
The recommendations would be used as a reference for selection of the students for
the programme (to be filled in by the teachers only):
Referee 1:
Given Name: ____________________________________________________________________
Surname: ____________________________________________________________________
*Gender: F / M
__________________ (Office)
Email: ______________________________________________________________________
Designation: ______________________________________________________________________
School: ______________________________________________________________________
1. How long have you known the candidate?

_______________________________________ years
2. What is your relationship with the student? (Eg. principal, form teacher, science
teacher, etc)
_______________________________________
3. Why would you recommend your student to join this programme?

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Page 7 of 8
Referee 2:
Given Name: ____________________________________________________________________
Surname: ____________________________________________________________________
*Gender: F / M
__________________ (Office)
Email: ______________________________________________________________________
Designation: ______________________________________________________________________
School: ______________________________________________________________________
4. How long have you known the candidate?

_______________________________________ years
5. What is your relationship with the student? (Eg. principal, form teacher, science
teacher, etc)
_______________________________________
6. Why would you recommend your student to join this programme?

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Page 8 of 8

Lampiran 2. Registration Form - Students (With Interview QNS)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Lampiran 2. Registration Form - Students (With Interview QNS)

Uploaded by

Copyright:

Available Formats

Annexe A1-­­ Registration Form for Students

Temasek Foundation International -­­ Science Centre Board STEP STEM

COMPLETE ONE FORM PER STUDENT

Given Name: ____________________________________________________________________

Date of Birth: ____________________________________________________________________

NRIC/Passport No.: _______________________________________________________________

Contact No.: __________________ (Mobile)

Secondary Email: _________________________________________________________________

Mailing Address: ____________________________________________________________________

Mailing City, State, Country: __________________________________________________________

Mailing Zip, Postal Code:______________________________________________________

Name of School/Institution: ______________________________________________

Dietary requirements (eg. Vegetarian, allergy to seafood, etc):

Medical Conditions (if any): ______________________________________________ T-­­shirt size:

Next of Kin Name: ____________________________________________________________

Postal Code: ____________________________________________________________________

Primary Phone: _________________________________________________________________

Alternate Phone: ________________________________________________________________

I, [Name of student]_____________________________________, [NRIC/Passport

Signature of student: ______________________________

Acknowledgement of Risks and Undertaking

No.]__________________________ am aware that my participation in some of these activities may

Signature of student: ______________________________

Name of *Parent / Guardian:

Postal Address: ________________________________________________________________

Telephone number: ________________________________________________________________

NRIC/ Passport no.: _______________________________________________________________

Declaration by Parent / Guardian:

Signature of Parent / Guardian: ______________________________

1. Why do you think you should be selected for this programme?

2. What do you hope to achieve or learn from the camp?

4. What do you want to do after you leave the school?

Contact No.: __________________ (Mobile)

1. How long have you known the candidate?

3. Why would you recommend your student to join this programme?

Contact No.: __________________ (Mobile)

4. How long have you known the candidate?

6. Why would you recommend your student to join this programme?

You might also like

Annexe A1- Registration Form for Students

Temasek Foundation International - Science Centre Board STEP STEM

Medical Conditions (if any): ______________________________________________ T-shirt size: