Application Form

Course Applying For:
*

University: Edith Cowan University, Western Australia
Macquarie University, Australia
Southern Cross University, Australia
Grenoble Graduate School of Business, France
University of Bradford, UK
University of Sunderland, UK
University of Wales, UK
Oklahoma City University, USA
Ottawa University, USA
Others:

Mode of Study

DayEvening

Student Protection Scheme

Opt-inOpt-out

Mode of Payment

FullInstalmentModular

1. PERSONAL PARTICULARS


Recent Photograph		*

Name	:	*
Title	:	*
NRIC/FIN No.	:	*
Passport No. (Applicable for non-Singaporeans and PR only)	:	*
Address	:	*
Postal Code	:	*
Contact No	:	(Home)
	:	*(Mobile)
	:	(Office)
Email	:
Gender	:	MaleFemale
Date of Birth	:	*(dd/mm/yyyy)
Nationality	:	*
Employment Status	:	Singapore CitizenStudent PassWork Permit Permanent ResidentEmployment PassProfessional Pass Others (specify):
Marital Status	:	SingleMarriedOthers
National Service	:	ExemptedRegularFull-time NS man Completed Full TimeNot applicable
ORD Date	:	*(dd/mm/yyyy)

2. EDUCATIONAL QUALIFICATIONS

All copies of transcripts, certificates and degrees must be stamped “CERTIFIED TRUE COPIES” and attached together with the completed application form. Certification may be made by your company. Please state down the name, NRIC No. and position of the person certifying the photocopies. Certification may also be made at MDIS upon presentation of original academic documents.

SECONDARY SCHOOL / JUNIOR COLLEGE / PRE-UNIVERSITY (‘N’ / ‘O’ ‘A’ Level)
From		To		Qualification	Institution
Mth	Year	Mth	Year	Qualification	Institution

TERTIARY EDUCATION (DEGREE/DIPLOMA)
From		To		Qualification	Institution
Mth	Year	Mth	Year	Qualification	Institution

PROFESSIONAL QUALFICATIONS / OTHERS
From		To		Qualification	Institution
Mth	Year	Mth	Year	Qualification	Institution

3. SUPPORTING DOCUMENTS

You may wish to provide extra information which you consider could assist your application. If you have any disability which may affect your learning (eg. vision, health mobility) you should provide early advice so the University may assist you. Please select the zip file containing the document(s) to upload.

4. COMPANY DETAILS

Name of Company	:
Address	:
	:
Postal Code	:
Contact No.	:	(O)
	:	(DID)
Designation	:
Nature of Business	:
Job Title refer to this table	:
Monthly Salary	:	Below $1000$1001 - $ 2500$5501 - $6000 $4001 - $ 5500$2501 - $ 4000Above $6000
Total number of years of work experience to date (NS included)	:	Yrs Mths
Total number of years of work experience to date (NS not included)	:	Yrs Mths

WORK EXPERIENCE : (Starting with current company and position)
From		To		Company	Designation
Mth	Year	Mth	Year	Company	Designation

Table 1 - Job Title
Top Management One who oversees a whole group of companies and his/her immediate subordinates	Non-Managerial Professional / Technical Executive A professional whose work does not generally require managerial / supervisory functions
Senior Management One who heads a subsidiary company, division or department and his/her immediate line subordinates	Non-Executive Staff One who supports at an administrative or clerical level of duties
Middle Management One who heads a section / department within a large division or department and his/her immediate line of subordinates	Sole Proprietor / Self Employed One who manages his own business
Junior Management One who oversees at least one subordinate	Student One who is studying full-time and not employed

5. COMPANY SPONSORSHIP (if applicable)

For company-sponsored applicant, the full amount of course fees must be paid. Membership fees must be paid together with the payment of the course fee.

Is your company an MDIS Institutional member?	YesNo
Is your company sponsoring you for the membership fee?	YesNo
Are you covered under the Skills Development Fund scheme?	YesNo

For company sponsored participants - Skilled Development Fund, companies sponsoring the participants are liable to pay the Institute the full course fee in the event of any of the following circumstances:

Participants withdraw from the course
Participants failed to complete the course within the Institute’s stipulated timeframe of the course
Participants are no longer under the employment of the sponsored company
Participants are being retrenched from the sponsored company
SDF Claim is being rejected by SDF

In the event the company ceases operation, the course fee portion supported by SDF shall be borne by the participant.

COMPANY CERTIFICATION:
We certify that all information made on this application are true and complete to the best of our knowledge. We agree that any misrepresentation or omission is sufficient grounds for rejecting the application. We authorise any investigation of the above information for the purpose of verification. If admitted, the company-sponsored applicant will not be asked to absent himself/herself from lessons except for urgent assignments.

Name of official	:
Designation :	:

6. ADDITIONAL INFORMATION

Please indicate how you came to know about the course? (Please tick the appropriate box)

Press AdvertisementAPC:
WebsiteLecturer / Trainer:
TV / RadioMDIS Student:
Brochure / Mailer / FlyerMDIS Staff:
Personal ContactOthers:

(name)

7. PARENT / GUARDIAN (For applicants below 21 years old)

Name of parent/guardian	:
NRIC No.	:
Address	:
Postal Code	:
Contact No	:	(Home)
	:	(Mobile)
	:	(Office)
Relationship to applicant	:
Occupation:	:

8. DECLARATION (all applicants must complete)

I hereby apply for the course as indicated in this form and membership for the Management Development Institute of Singapore. I declare that all information given is true and correct. I also agree to abide by the decision of the Institute as to my eligibility for the course. If accepted, I agree to abide by the Constitution of the Institute and pay the corresponding entrance fee and annual subscription for the category of membership.