Learning Express 2019 Registration Form

This form is for current Year 1 students in Singapore Polytechnic. Incomplete forms will not be processed. Past participants are not eligible to apply.
Email address *
Full Name *
Name as in NRIC / Passport. Example: Tan Chun How (capitalize first letter of each word)
Your answer
Admin No. *
SP Student Admin Number without prefix "P"
Your answer
Gender *
School *
Course *
Full course name. Example: Diploma in Chemical Engineering
Your answer
Contact No. *
It must be a Singapore mobile number
Your answer
Full Name of Lecturer to Recommend You (Full Time SP Lecturer only) *
Please seek your recommending lecturer's agreement to be your referee before submitting the lecturer's name. Please omit the salutation of your lecturer and spell out his/ her name in full.
Your answer
Lecturer's Email Address *
Email format must be in email@sp.edu.sg
Your answer
Youtube Video Link or Google Doc Link *
Please tell us why you deserve to be considered for the LeX Programme (eg: leadership qualities, good character, special talent, strong community spirit, etc.) and share specific examples that demonstrate these qualities. Submit a short essay (150 words) through Google Doc link or a link to your YouTube video (2 min or less). Please ensure that the document is not private and is available for viewing before submitting it.
Your answer
Please select the dates based on your availability. We will try our best to fit your schedules. *
You may choose more than one
Required
Declarations
Please complete the following declarations to the best of your knowledge. All declarations will be kept confidential.
Have you been convicted in a court of law in any country? *
Do you have a disciplinary record with Singapore Polytechnic? *
Have you ever been diagnosed with any mental disorders? *
Others
Please complete the following section to help us improve the Learning Express programme.
How did you hear about the Learning Express programme? (Tick all that apply)
Would you be interested in signing up for other International Programmes? (Eg: Temasek Foundation International – Specialist Community Action & Leadership Exchange (TFI SCALE), ASEAN Youth in Action (AYIA), etc.) *
A copy of your responses will be emailed to the address you provided.
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