Needy Pupil Fund (Non-Singaporeans).pdf - HCI EdTech Wiki - Hwa ...
Needy Pupil Fund (Non-Singaporeans).pdf - HCI EdTech Wiki - Hwa ...
Needy Pupil Fund (Non-Singaporeans).pdf - HCI EdTech Wiki - Hwa ...
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HWA CHONG INSTITUTION (HIGH SCH)<br />
APPLICATION FOR <strong>HCI</strong> NEEDY PUPILS FUND<br />
Grants will be valid for the year of application only.<br />
P09<br />
Laptop<br />
Subsidy<br />
Programme<br />
Section I: Particulars of Student<br />
Full Statutory Name (Underline Surname): Class : BC/NRIC /FIN<br />
No:<br />
Home Address:<br />
Current ISB subsidy,<br />
if any:<br />
100%/90%/75%/50%<br />
/33%*<br />
Nationality:<br />
Confirmation of<br />
IS B status by<br />
Admin Office<br />
(= awarded )<br />
Singapore(<br />
) Contact No:<br />
Current Recipient of bursary or scholarship, if any<br />
e.g. EESIS/ESIP/AEP/SAP:<br />
Name of bursary/scholarship Date of expiry Value of award<br />
Confirmation of status by Admin Office<br />
( : awardee)<br />
Section II: Particulars of Family Members (if you are currently an IS Bursary recipient, you<br />
need NOT complete this section)<br />
a) List down particulars of family members residing in the same household or who contribute to the income<br />
of the household.<br />
b) ‘Dependent children’ refer to unmarried children under16 years of age or unmarried children over 16 years<br />
receiving full time education, or unmarried handicapped children.<br />
c) Deceased/separated/divorced status of parents is to be indicated in 'Age' Column.<br />
d) Submit a photocopy of each supporting document of the following for verification purposes:<br />
- Family Income (employer’s letter or recent pay slip or latest Income Tax Assessment Return)<br />
- ‘Unemployed’ Status of parent including housewife (written declaration)(form obtainable from admin<br />
office)<br />
- For self-employed family members (latest Income Tax Assessment Return)<br />
Name<br />
BC/NRIC/FIN<br />
No.<br />
Age Relationship Occupation/<br />
Student<br />
Name of<br />
Employer/School<br />
Gross<br />
Monthly<br />
Income $<br />
Add Other sources of income (if any)<br />
Name of organisation giving assistance<br />
Amount per month<br />
Total<br />
Income verified by<br />
Admin Office( )<br />
1
Section III: Other considerations (eg: dependents with medical needs, sudden loss of breadwinner)<br />
------------------------------------------------------------------------------------------------------------------------------<br />
------------------------------------------------------------------------------------------------------------------------------<br />
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Section IV: Purpose of <strong>Fund</strong><br />
Offer details (attach supporting documents)<br />
E.g. School fees (only<br />
applicable to <strong>Non</strong>-ISB<br />
recipients)),<br />
Exchange programmes,<br />
School camps, CCA<br />
coaching fees<br />
Total Cost<br />
$<br />
$<br />
Subsidy<br />
applied for<br />
Section V: Declaration<br />
1. I declare that the particulars provided above are true to the best of my knowledge<br />
2. I undertake to refund the value of financial assistance received if any of the information is<br />
subsequently found to be false.<br />
Name of Parent/Guardian: Mr/Mrs/Mdm _______________________________________________<br />
Signature of<br />
Parent/Guardian: ________________________________ Date: ________________________<br />
---------------------------------------------------------------------------------------------------------------------<br />
Section VI: To be completed by school<br />
Status of Application: Approved Rejected<br />
Income Ceiling GHI < $1,500<br />
GIPDC < $600<br />
$ 1,501 - $2,500<br />
$ 601 - $1,000<br />
$2,501 - $3,750<br />
$1,001 - $1,500<br />
$ 3751 - $4,500<br />
$1,501 - $1,800<br />
$ 4,501 - $7,200<br />
$1,801 - $2,900<br />
Category of<br />
applicant<br />
Recommendation by<br />
approving panel<br />
w..ee...f<br />
ff: ::<br />
• GHI: Gross Household Income GIPDC: Gross Income per Dependent Child<br />
If the quantum applied for is<br />
Approving Panel<br />
< $ 2,500 DPSPSS , DPAE or DSC / SC<br />
> $ 2,500 DPSPSS , DPAE, DSC or SC<br />
Approved by DPSPSS<br />
Approved by DPAE<br />
Approved by DSC / SC<br />
signature<br />
signature<br />
signature<br />
---------------------------<br />
--------------------------- ---------------------------<br />
DDaat ttee: ::<br />
P09 (Revised 9 Oct 08)<br />
DDaat ttee: :: DDaat ttee: ::<br />
2