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Admission to Undergraduate Programmes (Full-Time) Application Form for students with Indonesian SMA UAN Qualification

Office of Admissions and Financial Aid Close

IMPORTANT: Please do not print or download the blank application form. Submit the application on-line and only one electronic application form can be submitted. Duplicate applications will not be processed. Please note that this form has to be completed in English. You will be provided with an Application Number if the on-line submission is successful. If you are not given an Application Number, please submit your application again. * Required information is marked in PURPLE

Personal Particulars Name (as shown in passport or KTP) (eg. TAN AH PEK JOHN) Passport/KTP/SMA Nomor Induk(eg. E1234567. Please do not type any additional words (eg. passport, etc) beside the number)

Permanent Home Address (Please provide your complete address and break your address into lines 1, 2 & 3, use abbreviation where possible and leave only one spacing between each word. Do not exceed 150 characters including spaces in total.)

Postal Address (if different from permanent address)

For Singapore Address, please provide your address here:

Block/House No: # - Postal Code:

For Foreign Address, please provide address here: For Foreign Address, please provide address here: Address (Line 1)

Address (Line 1)

Address (Line 2)

Address (Line 2)

Address (Line 3)

Address (Line 3)

State/Province

State/Province

Postal Code/Zip

Postal Code/Zip

Country Country

Home Phone

- - Country code - Area code - Local Number

Contact Phone

- - Country code - Area code - Local Number

Fax - - Country code - Area code - Local Number

Fax - - Country code - Area code - Local Number

E-mail1

E-mail2 (if any)

(Please provide a valid email address as your application outcome will be notified through email. If you do not have an email account, please choose and apply for one at http://email.about.com/od/freeemailreviews/tp/free_email.htm)

Date of Birth (DD-MON-YYYY, e.g. 29-SEP-1989)

Gender

Admission to Undergraduate Programmes (Full-Time)

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Admission to Undergraduate Programmes (Full-Time)

Citizenship Specify if others Are you a Singapore Permanent Resident?

Country of Birth Specify if others

Religion Mobile/Handphone - Country code - Mobile Number

Particulars of Parents

Father Mother

Name

Occupation

Office Address (if available)

Office Telephone (if available)

- - Country code - Area code - Local Number

- - Country code - Area code - Local Number

Choice of Programme (To provide at least first choice. Do not repeat choices). Click here to find out more on programmes available and check on the Minimum Subject Requirements. First Choice

Second Choice

Third Choice

Fourth Choice

Fifth Choice Note: 1. Students who are offered Engineering programme will be streamed into either Civil, Electrical & Electronic, Mechanical or Environmental Engineering in

the second year of study on the basis of their first year university results and competition. 2. Applicants interested in the double degree programmes offered under Engineering & Economics are allowed to choose no more than 2 from the 11

programmes available. 3. If you choose Art, Design & Media as one of your choices, please take note of the additional supporting documents that you need to submit within 2

weeks after receiving the invitation for faculty test. 4. Please note that Arts (Education) and Science (Education) are teachers' training programmes. Successful applicants will be bonded to serve the

Singapore Ministry of Education for 4 years. 5. Please note that some of the lessons related to Biomedical Sciences programme are conducted in Chinese. To apply for the programme, you need to have

at least a pass in Chinese at Junior High School level. This programme is not applicable to Chinese nationals. Financial Status

I intend to request for Tuition Grant assistance and I will be paying the Subsidised Tuition Fee. I understand that I will need to work for any Singapore registered companies for 3 years after graduation under this scheme.

I do not intend to apply for Tuition Grant assistance, I will be paying Non-Subsidised Tuition Fee. I understand that I will not be eligible to apply for Tuition Grant, Tuition Fee Loan and NTU Study Loan for the whole duration of study in NTU should I be admitted under the Non-Subsidised Tuition Fee Scheme. In addition, I am required to produce a S$30,000 Banker's Guarantee if I am admitted.

Educational Qualifications Please indicate your academic status:

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Admission to Undergraduate Programmes (Full-Time)

Still studying or just completed high school and awaiting for results . The results will be available in MON-YYYY eg.OCT-2008 SLTP

Final Exam Year Nama Sekolah

SMA

Final Exam Year Program (IPA/IPS/Bahasa) In Accelerated Programme?

Nama Sekolah

If the nama sekolah of your high school is not found above, please provide here

School Name:

School Address:

SMA School Records Please provide results according to your program of study as shown below: IPA - Bahasa Inggris, Bahasa dan Sastra Indonesia, Matematika, Fisika, Biologi, Kimia IPS - Bahasa Inggris, Bahasa dan Sastra Indonesia, Matematika, Ekonomi, Sejarah Nasional dan Sejarah Umum, Sosiologi or Geography Bahasa - Bahasa Inggris, Bahasa dan Sastra Indonesia, Matematika, Sejarah Nasional dan Sejarah Umum, Ekonomi or Sejarah Budaya, Sosiologi or Sastra Indonesia

Kelas 1/Kelas 10 Semester 1 Tahun (eg 2005/2006) Kelas 1/Kelas 10 Semester 2 Tahun (eg 2005/2006) Subjects Konsep Subjects Konsep

Kelas 2/Kelas 11 Semester 1 Tahun (eg 2006/2007) Kelas 2/Kelas 11 Semester 2 Tahun (eg 2006/2007) Subjects Konsep Subjects Konsep

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Sample. Do not attempt to apply using this form

Admission to Undergraduate Programmes (Full-Time)

Additional Education Information (if any). Please list any other courses attended after high school. (e.g. Jan 2004 - Dec 2005, Diploma in Computer Science, Informatics Computer School, Singapore). Students who are studying/have attended programs in university, please indicate Cumulative CAP/GPA obtained (e.g. Monash University (Malaysia Campus), Cumulative CAP/GPA - marks obtained / maximum marks).

Your information must not be more than 200 words.

Number of words typed English Language Proficiency (Please enter the scores that are applicable to you) The following information will be used for exemption of Qualifying English Test if you are admitted. Please leave blank if not taken or test result is not yet available or already expired (IELTS and TOEFL results are only valid for 2 years from the date of the test). For results available after application, please submit result slip for updating after your admission is confirmed.

TOEFL Year Taken Score

SAT 1Month-Year

(MON-YYYY, e.g. Jun-2007) Verbal Math

Essay (eg. 6, 7, 8)

IELTSDate

(DD-MON-YYYY, e.g. 01-Feb-2007) Band Writing

Outstanding Achievement Please list down outstanding achievements including medalist in International Science Olympiad competitions, represented country in international competition in the area of the Arts or Sports, in training team for International Olympiad Competitions. Please provide details (not more than 200 words).

Number of words typed NTU University Entrance Examination The Entrance Examination is scheduled in February 2009. If you are shortlisted to sit for an Entrance Examination, please indicate your

preferred examination venue : Please note that the preferred venue is tentative. The university will divert you to the closest venue should there be changes. Have you previously taken the NTU University Entrance Examination? Application History Have you applied to NTU previously?

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Sample. Do not attempt to apply using this form

Admission to Undergraduate Programmes (Full-Time)

Current Academic Status in Singapore Are you currently studying in or applying for in a School, Polytechnic or University in Singapore? Disabilities and Special Needs Have you had or do you have any communicable diseases, mental illness, colour blindness, and/or disabilities (including but not limited to chronic illnesses, visual or other physical constraints or limitations) which may or may not cause you to require special assistance or facilities while studying at the University? Criminal Offence Have you ever been convicted by a Court or Law of any country? Additional Information If you have any siblings or relatives who have studied or are studying in NTU, please provide details below:

Name RelationshipProgramme Study Year/

Graduated Year

How did you learn about the Nanyang Technological University? You may tick more than one box

Internet School Counsellor

Agent/Education Centre Presentation by NTU Representative

Advertisement-newspaper Education Exhibition

Advertisement-Studylink Sibling/friend/relative graduated/studying at the University

Posters/brochures in school Sibling/friend/relative working/residing/studying in Singapore

Study tour/tour to Singapore Sibling/friend/relative applying/applied to NTU

Others. Please specify Declaration I hereby declare that the information provided in this application is correct. I authorise the University to obtain official records, if necessary, from any educational institution attended by me. I understand that any provision of inaccurate or false information or omission of information will render this application invalid and that, if admitted on the basis of such information, I can be required to withdraw from NTU or liable to prosecution in a court of law. Password Creation Please provide your preferred password. The length of your password must be between 8 to 20 characters. You may use numbers, alphabets and symbols. The password is case-sensitive, i.e. if you have used a Capital Letter, e.g. 'A', you cannot enter 'a' in small case when logging in. You are reminded to remember your password and keep it confidential.

(enter your 8 to 20 characters password here) IMPORTANT: INCOMPLETE APPLICATION WILL NOT BE PROCESSED

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Admission to Undergraduate Programmes (Full-Time)

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