2014 DR GOH KENG SWEE (GKS) SCHOLARSHIP INSTRUCTIONS TO APPLICANTS

1. There are 3 parts in this application you must complete Form, Essay and Declaration & Survey . All parts must be completed in English. Please be reminded that you must select the "Yes, I agree" option, to agree to the clause under Declaration. 2. Please note the following, in completing your application form: Yellow fields are compulsory and must be completed. Indicate 'Nil' if fields are not applicable. Blue fields should be entered if the relevant information is available. Please refer to the tab Sample Form within the file for your reference. Fields marked with a red triangle in the top right corner contains help text. Hover your mouse cursor over the field to read this text. Do not add, delete or format any cells in the application form. 3. Email completed applications (Form, Essay and Declaration & Survey) to applications@psd.gov.sg, by 19 February 2014. Incomplete applications and applications received after this date will not be considered. 4. Photocopies of your birth certificate/passport and educational certificates must be produced for verification purposes upon request.

Personal and Family Particulars

Tsaqif Alfatan Nugraha 10/12/1996 Indonesia 1A11AB3818EMPS Family Background Father Tamtomo Prihanto Indonesia soldier

Academic Results
Muhammad Husni Thamrin high school 2011-2014 Surat Tamat Sekolah Menengah Umum Tingkat Atas 2014 Grade Subject A Chemistry A Physics A Mathematics B English B Indonesia language B History B Biology

Prizes / Awards / Co-Curricular Activities

Notable Achievements East Jakarta Physics Competition 1st place Jakarta physics competition 9th place Hipocrates Medical Championship Semifinalist Year 2013 2013 2013

Other Information
Application for University Admission Singapore Universities 1st choice Nanyang Technological University Electrical engineering & Economics Pending Applicant's Acceptance of Offer 2nd choice Select an option Select an option 3rd choice Select an option Option Select an option 4th choice Select an option Option Select an option 5th choice Select an option Option Select an option Overseas Universities Option

Double Degree

Option

Mother Rini Agustina Indonesia Soldier Departement of militrary strategy Siblings Khansa aqila novilia Sister Indonesia Not have any occupation

Select an option

Are the above results your final results? If "No", please indicate expected date of receiving your final results:

No 04/2014

Select an option

Option SAT Scores (1) Scholastic Assessment Test I Critical Reading Math Writing Note: If your SAT I scores are not available yet, or if you are expecting a new set of results, you may update us via email by 1 March 2014. (2) Scholastic Assessment Test II National Score Percentile Select an option

Select an option

Option Select an option Application for Other Scholarship(s) Select an option Select an option

Select an option

Currently studying in SG under a scholarship? No

Select an option Select an option

Additional information Indonesia Islam Malay Single

Select an option Select an option

Essay
In the yellow field below in no more than 500 words, describe an experience or incident that has shaped your values. How did this experience or incident affect you? How did you change as a result of this experience or incident? In 2006, i went to my home town with my father to visits my mom that had duty right there.Rigt there i and my father stayed in my grandpa's house, because we arrive at 3a.m, but my mother stayed in her office. In early morning, when i slept, an earthquake happened suddenly but at that moment i didn't realize that an earthquake happened. Luckily when i wake up nothing happen to me but all parts of the building where i slept had been collapse. When my conciusnes already gained, i think that i must be dead already but the fact is not. Then i was worrying about my mother, because i couldn't call her phone. I thinked how if my mother couldn't stand over this incident, how about if she dead ?. But then at the night, she called me and said she is fine. I think this incident has changed my personality. Now, i become a person who always trying the best and never waste my life because my life is the precious thing i had. I always try to not make my parents disappointed to me because they arre the best people i have in my life.

Do you hold any citizenship, other than the one entered in the "Form" section? Do you hold Permanent Residence Status of any other country? Have you ever suffered, or are you suffering from any physical impairment, disease or mental illness? Have you ever been convicted in a court of law in any country? Have you previously applied for the Dr. Goh Keng Swee Scholarships? Have you studied in Singapore before?

No No No No No No

By submitting this form to PSC, I declare that the information provided in this application is correct. I declare that the information in all parts of this form are true to the best of my knowledge, and I have not wilfully suppressed any material facts. I understand that any provision of inaccurate or false information or omission of information will render my application invalid and that, if admitted on the basis of such information, I will be required to withdraw from the scholarship. Yes, I agree.

Survey
Thank you for you interest in the Dr Goh Keng Swee scholarship. To help us in our review and publicity efforts, please let us know where you have obtained information on the Dr Goh Keng Swee Scholarships

Please let us know if you have any other feedback or comments on the application exercise below.

None, Thank You