Application Form

Please ensure that you complete every question on the application form. Application forms that have incomplete information will not be processed. Please do not submit handwritten forms. This form may be downloaded from
Information about you Name Date of Birth Citizenship I/C No Home Address Singapore citizen
(Surname) (Given Name)

Age Singapore permanent resident


Home Phone E-mail

Mobile Phone

Name & Address of School and Department

Endorser’s Name Endorser’s Position Name of person to notify in case of emergency Relationship
Award Received

Endorser’s Email Endorser’s Contact No

Contact number

Academic and leadership awards received (Best 3 only)
Award Giving Body Date Received

Membership/Involvement in Environmental Clubs/Activities (Best 3 only)
Name of Organization / Environmental Activity Position / Involvement Inclusive Dates

I have read and understood the official guidelines for entry to the Bayer Young Environmental Envoy program. I agree to abide by and be bound by the guidelines and decisions of the judges, which are final and binding in all respects. I warrant that all information contained in this entry is true and accurate. I grant the organizers and sponsors all rights to use my name, photograph, videotape or likeness of me, and statements made by or attributed to me relating to the program, for any legal purpose including without limitation, advertising, publicity, and other commercial purposes, in any and all forms of media, including the internet, without further compensation.

Applicant’s Signature

ENDORSEMENT BY SCHOOL AUTHORITY I certify that the applicant is a student of the college/university. I certify that the information submitted pertaining to this application is true and correct based on college records. Date Endorser’s Signature over Printed Name and Designation

character. environmental projects. etc ( 200 words ) . hobbies. For example. community work. Name About Me Please provide a short write-up about yourself. school involvement. interest.Participant's Profile Please ensure that you complete this form and return it together with the application form. Please also include a photocopy of your Student ID card as proof of your course of study in the school.

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