2011StudentApplicationForm-INTLBilngual

City
College
aims
to
develop
its
students
to
impact
and
inspire
the
world
with
excellence,
ingenuity,
integrity
and
servitude

入学申请表格

国际学生

City
College

2985
Jalan
Bukit
Merah
Singapore
159457

Tel:
+65
6511
6833 Fax:
+65
6511
6844 Hotline:
+65
9386
0744 Email:
**************************.sg .sg

限于校方使用For
Official
Use
Only:
Serial
No.:

___________

Date
Received:

_____/______/______

(dd/mm/yyyy)

英文姓名（须与护照相同）:

（请用大写字母填写并用下划线勾出姓）(Please
write
in
BLOCK
letter
and
underline
surname)
中文姓名:
(If
Applicable)
国籍Citizenship:
护照号码Passport
No.:
性别Gender:

婚姻状况Marital
Status:

❑
男
Mal
❑
女
Femal
❑
单身Single
❑
已婚Married

宗教
❑ 基督教Christiani ❑ 佛教Buddhis 出生日期Date
of
Birth:
_____/_____/_____
(dd/mm/yyyy)
(日/月/年)

Religion
❑ 兴都教Hinduism
❑
回教Islam
2011年1月1日的岁数：Age
as
of
1
Jan
2011: _____________

❑
其他Others:
____________________

种族Race: _______________________________

新加坡住址Residential
Information
in
Singapore
大牌Block
/
House
No.: 街道Street:

门牌Unit:
#
邮区Postal
Code:
大厦Building:
电话Telephone 住家(Home):
6
行动电话Mo e:


电邮址Email:
海外地址Contact
Information
from
Overseas/outside
Singapore

地址Address:
城市City:
省State
/
Province:
邮区Postal
Code: 国家Country:

电话Telephone
:
❑新加坡剑桥普通水准考试预备班
(密集)
课程代码：PCOI
1月招生

为期：40
周

开课：2011年1月17日

报名截止日期：2011年1月31日

❑新加坡剑桥普通水准考试预备班

课程代码：PCO
1月招生

为期：96
周

开课：2011年1月17日

报名截止日期：2011年1月31日

❑中学预备班（中三）

6月招生


为期：5个

开课：2011年6月20日

报名截止日期：2011年7月22日

请附上過往成绩单副本。

Please
attach
copies
of
previous
result
slips.

列出所有你曾经就读的学校（小学至高中学府）List
all
educational
institutions
that
you
have
attended
(From
Primary
to
Secondary
Level)

年份Year
学校Name
of
Institution

最高等级

Highest
Standard
Passed

1.
英语是我的第一语文。

English
is
my
FIRST
LANGUAGE.
❑是YES
❑否NO

2.
我曾用英语学习上课。

(请附上文件证明
)

I
have
undertaken
studies
in
which
language
of
instruction
was
English.

(Please
give
details
and
supply
documentation.)

❑是YES
❑否NO

3.
我曾在过去两年内考过(TOFEL,
IELTS)
英语测验。



I
have
sat
for
an
English
Language
Test
(TOFEL,
IELTS)
within
the
past
2
years.

❑是YES
❑否NO

测验名称:
_______________________________ 测试日期:
_______________ 测验成绩:
__________
/
___________

Test
Name Test
Date Test
Score

6.
健康记录Health
Record
and
Other
Details

A)
你是否患有疾病或残缺而需要为学习作特别安排？

Do
you
have
any
disease
or
disability
that
would
require
special
facilities
or
affect
your
studies
in
any
way?

❑是Yes❑否No
若是，请注明：
_____________________________________________________________________

If
Yes,
please
state
briefly:

B)
你是否曾接受任何心理辅导或治疗？Have
you
ever
received
any
psychological
or
psychiatric
care?

_____
年
_____月

❑是Yes❑否No
若是，请注明时期： _____
年
_____
月 至
If
Yes,
please
state
the
period [MMYY]:
心理医生/辅导员

Name
of
Counsellor
/
Psychiatrist:

心理医生/辅导员联络电话：
Contact
No.
of
the
above
personnel:
请简单说明Please
relate
briefly:________________________________________________________________________________
▪ 下列其中一位须是申请者的担保人（如申请者在21岁岁以下）。

At
least
ONE
of
the
below
is
a
guarantor
of
the
applicant
(applicable
only

to
applicants
below
the
age
of
21
years
old)
▪ 下列其中一位须是申请者的紧急联络人。

At
least
ONE
of
the
below
is
an
emergency
contact
person
of
the
applicant.

▪
担保人必须在申请时是21岁的新加坡公民。

Guarantor
must
be
a
Singaporean
and
at
least
21
years
of
age
at
the
time
of
application.
姓名（按照身份证/护照中所显示）（请用大写字母填写并用下划线勾出姓）Full
Name
as
indicated
in
your
NRIC/Passport
(Please
write
in
BLOCK
letters
and
underline
surname)

住家地址

Residential
Address
: 婚姻状况Marital
Status:

关系

Relationship:
身份证或护照号：
NRIC
/Passport
No.:
❑ 单身Sin gle ❑ 已婚Married

住家电话

Telephone
(Home):

行动电话
Mobile
No:

❑ 其他Others:
______________________

职业
Occupation:
出身日期
Date
of
Birth:
____/_____/_____
(日/月/年)
如适宜请打勾

Please
tick
the
following
if
it
applies
to
you:
❑ 担保人Guarantor
❑ 紧急联络人Emergency
Contact

❑ ❑ 姓名（按照身份证/护照中所显示）

Full
Name
as
indicated
in
your NRIC/Passport:
住家地址

Residential
Address
:


婚姻状况Marital
Status:
关系

Relationship:
身份证或护照号：
NRIC
/Passport
No.: ❑ 单身Single
❑
已婚Marrie
住家电话

Telephone
(Home):
行动电话
Mobile
No:

❑
其他Others:
_______________________

职业
Occupation:
出身日期
Date
of
Birth:
____/_____/_____
(日/月/年)
如适宜请打勾

Please
tick
the
following
if
it
applies
to
you:
❑ 担保人Guarantor
❑ 紧急联络人Emergency
Contact

姓名（按照身份证/护照中所显示）

Full
Name
as
indicated
in
your NRIC/Passport:
住家地址

Residential
Address
:


婚姻状况Marital
Status:
关系

Relationship:
身份证或护照号：
NRIC
/Passport
No.: ❑ 单身Single

❑ 已婚Marrie
住家电话

Telephone
(Home):

行动电话
Mobile
No:

❑
其他Others:
_______________________

职业

Occupation:
出身日期

Date
of
Birth:
____/_____/_____
(日/月/年)

如适宜请打勾
Please
tick
the
following
if
it
applies
to
you:

❑ 担保人Guarantor

❑ 紧急联络人Emergency
Contact

完成学业后的目标是什么？What
do
you
expect
to
achieve
after
studying
the
programme
here
in
City
College?

❑考入理工学院

Possible
entry
to
a
Polytechnic
(L1R4
<25)
❑考入初级学院

Possible
entry
to
a
Junior
College
(L1R5
<
20)

❑考得3科’O’水准

Attain
3
‘O’
Level
Credits

❑考取’O’水准证书Att
ain
‘O’
Level

Certification

❑其他，请列明Othe
please
state:

您是如何获知City
College的讯息？若适宜请打勾How
did
you
find
out
about
City
College?
Please
select
all
that
applies.

❑City
College
网站City
College
website
❑其他网站Other
websites
that
referenced
City
College

❑City
College
学生简章 City
College
Prospectus

❑搜索引擎Search
Engines (Google/Yahoo/Bing/Others)
❑网上广告Online
Advertisements
❑社交网Social
networking
websites
(Facebook/Ammado/Others)

❑报章杂志报道Newspaper/magazine
repo❑报章杂志广告Newspaper/magazine
Advertisement

❑中介Education
Specialists (Agents)

❑亲戚朋友
(Friends/Relatives)
❑网上论坛Online
discussion
forums
❑其他，请列明

Others,
please
state:

_______________________________________________________________________________

学生同意STUDENT’S
ACKNOWLEDGMENT

我，__________________________(姓名)，在今天________________(日/月/年)了解并同意，City
College
已让我了解迟入学的细节，而我也完全了解其中的意思。

我确定我将继续完成接下来的入学手续。



I,
__________________________
[name],
hereby
acknowledge
that
on
this
date ________________
[DD/MM/YYYY],
City
College
has
brought
to
my
attention
the
details
of
the
Late
Entry
Notice and
I
fully
understand
the
content.
I
hereby
confirm
that
I
will
proceed
onto
the
admission
procedure.

1.我愿意报考成为City
College的学生并宣告所填的资料全属完整正确。



I
wish
to
be
considered
for
admission
as
a
student
at
City
College
and
declare
that
the
information
submitted
is
correct
and

complete.
2.我了解City
College可能会向我之前的学校索取我的履历报告。

I
understand
that
City
College
may
obtain
official
records
from
any
schools
previously
attended
by
me.
3.我了解City
College有权在发现资料不正确下更改初出的决定。



I
understand
that
City
College
reserves
the
right
to
vary
or
reverse
any
decision
made
on
the
basis
of
incorrect
or
incomplete
information.
4.我确定我会做出安排并有能力缴付学费。



I
declare
that
I
am
able
to
make
appropriate
arrangements
to
fund
the
full
cost
of
my
studies.
5.我赋予City
College权利将我的资料提供给校外机构，不论是数字报告或对我无利的报告。



I
herewith
give
City
College
permission
to
provide
my
details
of
admission
for
purposes
external
to
the
college,
when
it
is

statistical
form
or
when
it
is
not
to
my
disadvantage
for
this
to
be
done.
_________________________________

申请者签名Signature
of
Applicant

姓名Name:
______________________

__________________________

日期Date

21
我确定所提供的所有资料所属完整正确。

I
hereby
agree
that
ALL
the
information
provided
here
is
COMPLETE
and
TRUE.

__________________________________
____________________________
_________________________
家长/监护人身份证/护照号码

Parent's
/
Guardian's
Passport
/
NRIC
No.

签名Signature

日期Date

13.
City
College
将确保学生的个人资料受到保密并不对外泄漏任何有关学生的个人详情除非得到学生的同意书面通知。



City
College
is
committed
to
maintaining
the
confidentiality
of
the
student's
personal
information
and
undertakes
not
to
divulge
any
of
the
student's
personal
information
to
any
third
party
without
the
written
consent
of
the
student.

保密条规列外情况: The
confidentiality
undertaking
has
the
following
exceptions:

1.所有记录将用于行政与课业事物及其工作人员所使用。



All
records
are
available
to
the
administration
manager,
faculty
and
staff
of
City
College,
having
legitimate
educational
concerns.
2.若在可能危害他人的情况或事关学生健康的情况下，校方将对医务人员提出学生的健康情况资料。



Appropriate
information
would
be
released
to
medical
personnel
should
the
health
of
the
student
or
others
would
be
endangered
by
the
withholding
of
information.

3.按法律或公务的情况下，校方将提供但不限于在申请学生证，将其他资料给政府机构或其他法定机构的工作人员。



Specific
data
would
be
given
to
the
governmental
officials
and
agencies
designated
by
law,
or
in
compliance
with
a
judicial
order,
including
but
not
limited
to
the
application
and
process
of
student
pass
for
international
students.

4.适当的资料将用于学生的迎新与实际学习用途。



Appropriate
information
may
be
released
for
the
orientation
and
practical
training
program
of
students.

完整的填上报名申请表格并附上以下的文件：The
completed
application
form
must
be
accompanied
by
the
following
documents:

❑2张护照相片2
recent
passport
size
photographs

❑护照及学生证副本（正反面）A
copy
of
your
Passport
and
Student
Pass
(front
and
back)

❑担保人的身份证副本（正反面）A
copy
of
your
guarantor’s
NRIC
(front
and
back)
❑过往4年公证的中学/初中学习报告/成绩单A
set
of
your
high
school
report
book
and
latest
result
slips
for
the
past
4
years

❑公正的出生证/家长身份证/护照及充足的财务证明
Certified/Notorized
copies
of
Birth
Certificate/Parents’
Passport/ID
and
proof
of
sufficient
funds.

❑移民局的学生证申请表格（Form16及Form
36）
Completed
Student
Pass
Application
Forms
(Form
16
&
Form
36)

❑新币$214.00
报名费A
S$214.00
Application
Fee
**

若有兴趣申请奖学金，你须附上If
you’re
keen
to
apply
for
City
College
Scholarship,
you
are
also
required
to
submit::

❑过往4年获领的奖状/奖章/文凭等Academic
awards
and
co‐curricular
activities
/
awards
certificates
for
the
past
4
years

**
请不要寄现金。

请到我们的办公处缴交所有费用。

办公时间：周一至周五，上午9点至下午6点。

谢谢合作。

We
do
not
accept
cash
payment
via
post.
Kindly
make
payment
at
our
office
from
Monday
to
Friday,
9am
to
6pm.
Thank
you
for
your
cooperation.
将所有表格及文件寄至The
completed
application
package
should
be
returned
to:

Admissions
Office
City
College

2985
Jalan
Bukit
Merah
Singapore
159457

Tel:
+65
6511
6833 Fax:
+65
6511
6844 Hotline:
+65
9386
0744

Email:
**************************.sg
.sg
。