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USTPM

Admission to Undergraduate Programmes (Full-Time)
Application Form for STPM/UEC Qualifications
Office of Admissions & Financial Aid IMPORTANT: Please note that this form has to be completed in English. 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. Note: 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 fields.

Personal Information
Personal Particulars Title / Full Name (as shown in passport, Identity C ard or Birth C ertificate) First / Given Name Last / Family / Surname Passport / Identity C ard No Mr BENEDIC T LIM FANG JUN BENEDIC T, FANG JUN LIM 941030125109
(eg. E 1 2 3 4 5 6 7 ) (eg. T A N A H P E K J O H N )

(for M alays ian, pleas e provide I C N o (with no hyphen). S'porean & S'pore P R s hould provide S'pore/P R I C N o. P leas e do not type any additional words (eg. pas s port, etc ) bes ide the number.)

Foreign Identification No. (FIN)
(for foreign s tudents only, if applic able)

Are you a Singaporean or Singapore Permanent Resident? C itizenship: Gender: Date of Birth: Malaysian Male 30-Oct-1994
(D D - M M M - Y Y Y Y , e.g. 0 5 - M ar- 1 9 9 6 )

No C ountry of Birth: Religion: Mobile/Hand phone: Malaysia C hristian 60 - 168232795

C ountry c ode - M obile N umber (O mit C ountry C ode for Singapore N umber)

Address Provide only one address, either Singapore or Foreign. Do not provide both.

Permanent Home Address

Correspondence Address (if different from permanent address)
For Singapore Address, pleas e provide your addres s here: Postal C ode: Block / House No:

For Singapore Address, pleas e provide your addres s here: Postal C ode: Block / House No: Unit Number: # -

Unit Number:

#

-

For Foreign Address, pleas e provide addres s here: Address (Line 1): Address (Line 2): Address (Line 3): State / Province: Postal C ode / Zip: C ountry:

For Foreign Address, pleas e provide addres s here: P.O Box 12491, 88827 Kota Kinabalu, Sabah Malaysia Sabah 88827 Malaysia

C -03-1, Block C , Alam Damai C ondominiums Address (Line 1): Jalan Bukit Padang, Kota Kinabalu Sabah, Malaysia Sabah 88300 Malaysia Address (Line 2): Address (Line 3): State / Province: Postal C ode / Zip: C ountry:

For Contact Number, pleas e provide number here: Home phone: 606 8 - 088251397

For Contact Number, pleas e provide number here: C ontact phone: -

C ountry c ode- A rea c ode - L oc al number (O mit C ountry & A rea C ode for Singapore number)

C ountry c ode- A rea c ode - L oc al number (O mit C ountry & A rea C ode for Singapore number)

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 E-mail1 blimfangjun@yahoo.com E-mail2 (I f any) xgu3sswho@hotmail.com

Particulars of Parents Father Name: Occupation: Office Address: (if available) Office Telephone: (if available) David Lim Jit Sung Manager Mother Alice Yap C hing Mee Executive

C ountry c ode- A rea c ode - L oc al number

C ountry c ode- A rea c ode - L oc al number

Choice of Programme
(To provide at least first choice. Do not repeat choices). C lick here to find out more on programmes available and check on the Minimum Subject Requirements. First C hoice: Second C hoice : Economics Environmental Engineering

ht ps: / t / venus. i nt edu. adm _af w ebpages/ S T P M . w s. u. sg/ / U aspx

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Y Y Y Y . If you choose Art. 5. Educational Qualifications Please indicate your academic status: just been released in Dec-2012 -> Still studying or just graduated from high school Still studying OR just graduated from high school with either awaiting final results or just received final results. To apply for the programme. 2. Please note that some of the lessons related to Biomedical Sciences programme are conducted in C hinese. w s. A ) Level (For ST P M only. Hong Kong SAR and Taiwan. This programme is not applicable to C itizens of Mainland C hina. Science UEC (Malaysia) Sabah Tshung Tsin Sec School. Please note that Arts (Education) and Science (Education) are teacher training programmes. e. Applicants interested in the double degree programmes offered under Engineering & Economics are allowed to choose no more than 2 from the programmes available. M A R.) Bahasa Malaysia/Melayu English Language Physics Biology C hemistry Maths-E / Ad Maths I / Mathematik T/S Maths-H / Ad Maths II / Further Maths C hinese Language A1 A1 A1 A1 A1 A1 A1 A1 (Type subject below if not listed above) Summary of Grades obtained (for students taken STPM only) C lic k here to s ee s ample Gred Kertas Total obtained A A- B+ B B- C+ C C- D+ D F Additional Education Records Is Physics one of the subjects in your STPM/UEC ? Physics at SPM (for Sc ienc e s tudents where P hys ic s is not offered in ST P M ) Yes Year: 2011 Grade: Grade: A- Additional Mathematics/Matematik Tambahan at SPM ht ps: / t / venus. i nt edu. Successful applicants will be bonded to serve the Singapore Ministry of Education for 4 years.2 0 1 3 ) Please indicate your high school qualification: Study stream in High School: Name of High School: Provide UEC/STPM results. Students who are offered Engineering programme will be streamed into either C ivil. 4. Mechanical or Environmental Engineering in the second year of study on the basis of their first year university results and competition. 6. Design & Media as one of your choices. Electrical & Electronic. sg/ / U aspx 2/ 4 .g. The result will be available/ has (M M M . you need to have at least a pass in C hinese at GC E 'O' Level/Junior High School level.1/ 13 3/ Third C hoice: Fourth C hoice: Fifth C hoice: Note: USTPM C ommunication Studies Sociology Business 1. 3. Applicants interested in the LKC Medicine programme are to note that only those who have selected the programme as a first choice will be considered.Sabah (UEC ) Final Exam Year Subject Taken 2012 (eg 2 0 1 2 ) Grade Obtained A2 A1 B4 B6 B6 B5 B5 C8 Best Grade (eg A 1 . u. Selec t 'A dvanc ed' for all papers exc ept G eneral P aper. adm _af w ebpages/ S T P M . please take note of the additional supporting documents that you need to submit.

sg/ / U aspx 3/ 4 . e.) Please list any other courses attended after high school (e. Do you have any past or current physical health. (Format/E.) Have you ever been convicted in a C ourt of Law of any country? Additional Information If you have any siblings or relatives who have studied or are studying in NTU.g.2 0 1 2 ) C ritical Reading Band Math Writing Writing Essay (eg. illnesses or impairments which may or may not cause you to require special assistance. etc .) Writing: (eg.g.Feb2012) 8 6. 0 1 . I nformatic s C omputer Sc hool.5/5. etc . mental health or learning needs.Y Y Y Y . a Polytechnic or a University in Singapore? Disabilities and Special Needs Please note that students who are Hepatitis B carriers may not be admitted to the Medicine programme and will not be eligible for admission to the Biomedical Science & Chinese Medicine programme.4 . i nt edu. 0 1 .3 .5/5.M M M .Y Y Y Y . A 1 . B3 . A 2 . 0 1 . etc . A 1 . w s.Biology . support or facilities while studying at the University or within the Programme you have applied for? No If you are unsure about what may be important to list.) Provide your C ollegeBoard Advanced Placement (AP) results here (if any).) TOEFL Test Date (D D .g.Y Y Y Y . A 2 .g. u. SMU (Singapore Management University). SUTD (Singapore University of Technology & Design). please provide details below: Name Relationship Programme Study Year /Graduated Year No No No No ht ps: / t / venus.g.6 .5/5.M M M .C alculus AB . Singapore). e. J an 2 0 0 4 .5 PTE Academic Test Date (D D . NAFA-RC M (Nanyang Academy of Fine Arts-Royal C ollege of Music) or LASALLEGoldsmiths (LASALLE C ollege of the Arts-Goldsmiths C ollege)? Are you currently studying in a Private Education Institution.7 .) Have you applied to NTU previously? Academic Status in Singapore Have you previously studied or are you currently studying in NTU (Nanyang Technological University). e. please declare it anyway so that we could assess how we may assist and support you. disabilities. Number of words left 200 Y our information mus t not be more than 2 0 0 words . 4 3 .g. team training for International Olympiad C ompetitions. Statistics . Physics B 5/5. C hemistry .Y Y Y Y .) (eg. D iploma in C omputer Sc ienc e. adm _af w ebpages/ S T P M .) (eg. 5 . 2010 AP .D ec 2 0 0 5 . 2009 AP .M M M .Feb2012) Score Mode of test SAT 1 IELTS Test Date (M M M .8 ) Test Date 08-Dec-2012 (D D .1/ 13 3/ Additional Mathematics/Matematik Tambahan at SPM (for A rts /C ommerc e s tudents where M athematic s is not offered in ST P M ) USTPM Year: Year: Grade: Grade: C hinese at SPM (for ST P M only) E1119 C lick here to see sample results slip SPM English MUET (for STPM only) Additional Education Information (if any) Not taken Year: 2011 Year: 2011 Year: Grade: Grade: Grade: 1A A+ (eg.5/5. Criminal Offence (A pplicants applying f or LKCMedicine programme are required to complete an additional detailed declaration at the ‘tracking page’. UniSIM (SIM University). e. representing home country in international competitions in the area of the Arts or Sports.Feb2012) Overall Score Writing Application History (Information provided is for reference only and has no impact on your application. NUS (National University of Singapore). Number of words left 200 Y our information mus t not be more than 2 0 0 words . Achievements Outstanding Achievement Please list down outstanding achievements including medals received at International Science Olympiad competitions. J un. B3 . Other Information English Language Proficiency (Please enter the score that is applicable to you and provide only score that is still valid. SIT (Singapore Institute of Technology) . You may use this section to explain if there is any discrepancy in grade provided from documents submitted or the grading system in your school.

1/ 13 3/ USTPM How did you learn about the Nanyang Technological University? You may tick more than one box Internet Agent/Education C entre Advertisement-newspaper Advertisement-Studylink Posters/brochures in school Study tour/tour to Singapore Others. from any educational institution attended by me. I agree with the above declarations. I hereby agree to the retention. Design & Media Programme (if applicable). IMPORTANT: INCOMPLETE APPLICATION WILL NOT BE PROCESSED Submit Print Copyright © 2001-2010 Nanyang Technological University All Rights Reserved ht ps: / t / venus. or omission of information will render this application invalid and that. for the purpose of the administration of the academic programme for which I am enrolled at NTU. I am responsible for requesting official documents from the educational institution attended by me. I hereby also authorise the University to obtain official records. I understand that any provision of inaccurate or false information or forged supporting documents. In the case of assignments for Art. Please specify School C ounsellor Presentation by NTU Representative Education Exhibition Sibling/friend/relative graduated/studying at the University Sibling/friend/relative working/residing/studying in Singapore Sibling/friend/relative applying/applied to NTU Declaration I hereby declare that the information provided in this application is true and complete and all documents submitted in support of my application are true and honestly presented. adm _af w ebpages/ S T P M . they represent my own work. i nt edu. sg/ / U aspx 4/ 4 . I can be required to withdraw from the University or liable to prosecution in a court of law in Singapore. if admitted on the basis of such information. w s. if necessary. use and disclosure by NTU of any and all information provided by me in this application. u.

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