For existing NUS or SUTD student’s use only
Application Form For
JOINT DOCTOR OF PHILOSOPHY
(Note: This form is meant for applicants who are already enrolled as a student in NUS or SUTD)
To be Completed by Applicant
Name of Applicant:
(As appear in Identity Card/Passport and underline Surname/Family Name)
Please indicate your choices with a ( )
Intake Applied Current Source of Finance
August 20__ Lee Kong Chian Graduate Scholarship
January 20__ President’s Graduate Fellowship
Type of Programme NUS Research Scholarship
Self Financing
Full-Time
Others : _______________________________________
Part-Time
Department Applying To :
Biomedical Engrg Chemical & Biomolecular Engrg Civil & Env Engrg
Electrical & Comp Engrg Engineering & Technology Mgt
Industrial & Systems Engrg Materials Science & Engrg Mechanical Engineering
Home university:
NUS SUTD
Date of Enrolment at home university : _________________________ (DD.MM.YYYY)
Application form for Photograph
of
NUS-SUTD Joint Doctor of Philosophy Applicant
(1) PERSONAL PARTICULARS
Name (Write in BLOCK letters) Gender Age
Dr / Mr / Mrs / Mdm / Miss*
□ Male
(As at 31
(Please underline Surname/Family Name) □ Female Dec of this
year)
Permanent Home Address Telephone Number
Mailing Address Telephone Number
Fax Number (with
area code)
Address in Chinese characters (if applicable)
E-mail Address
Office Name & Address Telephone Number
Date of Birth (DD/MM/YY) Place of Birth Domicile (Country you live in Ethnic Group
permanently)
Marital Status No. of Children NRIC (for Singaporeans, PR or Malaysians Date & Place of Issue
only) :
Passport No. (if available) :
Type of NRIC
Singapore Pink Malaysian Blue Not Applicable
Singapore Blue Malaysian Pink
Citizenship (Please attach a copy of your citizenship status)
Singapore Citizen Singapore Permanent Resident
Others (Please specify: __________________ )
(2) PARTICULARS OF NEXT-OF-KIN
1
Name Relationship Occupation
Permanent Address Telephone Number
This page (Columns 3 – 5) to be completed by students of SUTD only.
(3) ACADEMIC QUALIFICATIONS
Please attach CERTIFIED COPIES of university transcript(s) and certificate(s).
(A) University (Undergraduate and Postgraduate) [Inclusive of programmes that you are currently reading]
From To Name & Location of University Degree awarded (pls Class/Rank Overall
#
indicate if degree is Year
(mm & yy) (mm & yy) pursued on a Full-Time
(FT) or *Part-Time (PT) Wt.Ave Grade &
basis)
/ Mark / GPA
1. Degree:
FT PT
(*period: ____________ )
2. Degree:
FT PT
(*period: ____________ )
(B) Membership of Professional Organizations (Please attach documentary evidence)
From To Organization Post Held Membership Status
(C) Scholarships, prizes or other awards received (Please list in chronological order and enclose documentary
evidence).
(4) LANGUAGES (Please state levels of proficiency - excellent, good, fair)
Spoken and Written Spoken Only Writing Only
(5) TOEFL AND GRE/GATE SCORES (If applicable)
Applicants may:
(i) request ETS to send original scoresheets to respective Departments of NUS [Institution code: 0677(GRE), 9084
(TOEFL)] or
(ii) submit scoresheets certified by their universities with an original stamp or
(iii) request NUS Department to certify their scoresheets if they are in Singapore.
TOEFL Scores GRE Scores GATE Scores
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Total Score : __________ Total Score : __________ Total Score : __________
TWE Score : __________ Verb: ____% Quant: ____% Analy: ___
%
Date of Test : __________ Date of Test : __________
Date of Test : __________
# Applicants with marks reflected in result slip/transcript are to calculate the overall weighted average (wt.ave), i.e total marks divided by
total number of subjects taken ( technical subjects plus English only).
For transcript with marks and grades, please compute ave. wt. marks and ave grades for all semesters.
For transcript with grades only, please compute average grades for all semesters.
Grade point average (GPA), please indicate if GPA is over a 4point, 5point or 10 point system etc. Thank you.
(6) RESEARCH EXPERIENCE/PAPERS PUBLISHED
If you have any publications, please list them below and enclose a copy of each publication.
(A) International Refereed Journals
(B) Others (National journals, papers etc)
(7) PROPOSED RESEARCH
(A) Proposed Research Area/Topic
Please indicate name of Research Institute/Centre (if applicable):
(B) Significance & Aims of Project
(This is optional. If you do not have something specific in mind, you may leave this portion out. Use a separate sheet for this).
(C) Proposed Supervisor(s) at NUS & SUTD
(Please fill this if you have someone in mind or have corresponded with him/her. Otherwise, a suitable supervisor will be
chosen for you. This could also include staff from Research Institute/Centre [where applicable]).
Note: Students are to spend at least 2 semesters/terms of their PhD candidatures at each partner university.
(8) CURRENT SUPERVISOR(S)’ DETAILS
Supervisor 1 Supervisor 2
3
Name Name
Designation Designation
Address Address
(9) OTHER INFORMATION
(A) Are you currently receiving any scholarship/awards at NUS or SUTD?
Yes (Please state: _____________________) No
(B) Have you previously applied for admission or have been admitted to any postgraduate programme(s) at NUS?
Yes (Please give details of all previous
applications No
below. If necessary, please use separate sheet)
(i) Programme(s) applied for : ________________________________
Year of application : ________________________________
Outcome of Application : Successful (please give details below)
Rejected
(ii) Date of enrolment : From __________________ To _________________
Current Status : Graduated Withdrawn
Failed Current student
(C) Are you applying for any other postgraduate programme(s) at NUS for the coming session?
Yes (Please give details below) No
Programme(s) applying for : _______________________________
(D) Disabilities and Special Needs
Have you had or do you have any disabilities (including but not limited to chronic illnesses, communicable diseases,
mental illness, colour blindness, visual or other physical constraints or limitations) which may cause you to require
special assistance or facilities while studying at the University?
Yes No
If yes, please provide all relevant information on a separate sheet of paper (and attach the relevant medical documents).
Note: This information will enable the University to develop a complete profile of an applicant and to determine
whether he/she might need additional resources in his/her studies. The University, however, does not guarantee
the provision of special aid (financial or otherwise) to any students.
(E)
i) Have you ever been convicted of any offence by a court of law in any country or are there any court proceedings
pending against you anywhere in respect of any offence? Yes No
ii) Are you currently, or have you ever been, charged with or subject to disciplinary action for any type of
misconduct, scholastic or otherwise, at any educational institution? Yes No
iii) Are you currently, or have you ever been, under investigation or subject to enquiry in respect of any
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misconduct, scholastic or otherwise, at any educational institution? Yes No
If your answer to any or all of the above questions is yes, please provide a full statement of relevant information on a
separate sheet of paper (and attach the relevant documents).
(10) DECLARATION
• I declare that the information provided by me in connection with this application is true and complete.
• I understand that any inaccurate, incomplete or false information given or omission of material information required shall render
this application invalid and NUS may at its discretion withdraw and offer of admission made to me on the basis of such
information or, if already admitted, I may be liable to disciplinary action, which may result in my expulsion from NUS.
• I understand that the provision of any inaccurate or false information may render me liable to prosecution in a court of law in
Singapore.
• I understand that if I have been convicted of a criminal offence by a court of law of any country, I must submit all relevant
information together with this application.
• I understand that the University has not engaged any external agencies to undertake graduate student recruitment on its behalf
and it reserves the right to reject without giving reasons to applications submitted through any external agencies.
• I hereby authorize NUS to obtain and verify any part of the information given by me from or with any source, as deems it
appropriate.
* Delete where appropriate
Personal Data Notice & Consent
(i) The National University of Singapore (“NUS”) manages and administers undergraduate and graduate courses
in NUS, including processing applications for the admission of candidates to NUS (“Admission”). To manage
and administer the undergraduate and graduate courses in NUS, including the applications for Admission,
NUS will necessarily need to collect, use, disclose and/or process certain personal data or personal
information about the individual that has submitted an application for Admission (the “Applicant”).
(ii) Such personal data will be collected, used, disclosed and/or processed by NUS for the purpose(s) of:
(a) Processing the Applicant’s interest in and application(s) for Admission;
(b) Administering and/or managing the Applicant’s application(s) for Admission and Enrolment;
(c) Making of any offer(s) of acceptance to courses in NUS;
(d) Administering and/or managing the Applicant’s relationship with NUS (including the mailing of
correspondence, statements or notices to the Applicant, which could involve the disclosure of certain
personal data about the Applicant to bring about delivery of the same, as well as on the external cover of
envelopes / mail packages);
(e) Carrying out due diligence or other screening activities (including background checks) in accordance with
legal or regulatory obligations or risk management procedures that may be required by law or that may
have been put in place by NUS, including the obtaining of references and/or other information about the
Applicant from the Applicant’s previous education institute(s);
(f) Responding to any enquiries by the Applicant;
(g) Processing the Applicant’s application(s) for scholarships and/or financial aid as part of the Admission
process, and if successful, administering and/or managing the Applicant’s scholarship and/or financial aid
programmes, which may include use of personal data for direct marketing purposes for development and
fund raising activities and disclosure of personal data to donors and/or external organisations for
purposes of event invitations, surveys and/or publicity of NUS' financial aid programmes;
(h) Investigating fraud, misconduct, any unlawful action or omission relating to the Applicant’s application for
Admission, and whether or not there is any suspicions of the aforementioned;
(i) Responding to requests for information from public agencies, ministries, statutory boards or other similar
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authorities (including but not limited to the Ministry of Defence, Ministry of Education and Ministry of
Health) from time to time;
(j) Carrying out market related or similar research and analysis for NUS' operational strategy and policy
planning purposes;
(k) If consented to by the Applicant in the registration form and/or other methods of consent notification,
sending the Applicant marketing, advertising and promotional information, including materials and
information on undergraduate and graduate courses in NUS, residential options and general student-
related activities within NUS, as well as related talks, seminars and/or events via postal mail, electronic
mail, SMS or MMS, fax and/or voice calls; and
(iii) Such personal data of the Applicant will/may be disclosed by NUS to third party service providers or agents
(whether in Singapore or elsewhere in the world where such service providers are sited) for one or more of the
above Purposes, as such third party service providers or agents, if engaged by NUS, would be processing the
Applicant’s personal data for NUS, for one or more of the above Purposes.
(iv) By completing and endorsing this application form, the Applicant :
(a) Consents to NUS collecting, using, disclosing and/or processing the Applicant's personal data for the
Purposes as described above; and
(b) Consents to NUS transferring the Applicant’s personal data out of Singapore to NUS’s third party service
providers or agents for the Purposes as described above.
(v) If the Applicant has any questions relating to NUS’s collection, use and disclosure of the Applicant’s personal
data, the Applicant may contact the Data Protection Officer at [email protected] or call 6776 2835 or such
other person as NUS may designate, from time to time, whether by informing the Applicant through any letter,
circular, notice or email.
(vi) For the avoidance of doubt, in the event that Singapore personal data protection law permits an organization
such as NUS to collect, use or disclose the Applicant’s personal data without the Applicant’s consent, such
permission granted by the law shall continue to apply.
Please read the above contents (Section 10) carefully. If you have read and fully understand the contents of
this section; and by endorsing this document, you hereby give your consent as set out above as well as
consent to NUS collecting, using, disclosing, processing and/or transferring out of Singapore, your personal
data for one or more of the purposes described in this document.
Name and Signature : _____________________________ Date : __________________
