Application for Asian Nursing Scholarship ( ANS )
ANS Registration Form
Full Name (As in IC) *
( eg: Ching Chew Ming Ivy )
New IC Number *
( eg: 991218-02-5852 )
DOB (dd-mmm-yyyy) *
( eg: 18-Dec-1999 )
Gender (Female/Male) *
Required
Nationality *
Required
Dietary Requirement *
Required
Valid Handphone Number (Include Country Code) *
( eg: 60123358992 )
Home Address *
Valid personal email address (Compulsory) *
Name of Next-of-Kin (NOK) *
(Name of Father / Mother / Guardian)
Relationship of NOK *
Required
Contact Number of NOK *
( eg: 60123358992 )
Highest Qualification (e.g Degree / Diploma / STPM/ SPM / UEC) *
Required
Year of SPM/UEC/O level obtained *
( eg: 2018 or 2017 or 2016 or 2015 ... )
Height (meter) *
( eg: 1.61 )
Weight (kilogram) *
( eg: 56 )
Race *
Religion *
Name of School *
( eg: SMK Ulu Tiram )
Any medical condition? or on long-term medication? (eg. Thyroid? Asthma? Diabetes? Hypertension? Scoliosis? Implant? What surgery? Color-blindness?) *
Please note down the below email address and email your UEC/SPM Certificate/SPM2019 Trial Result (Percubaan) to : *
Are you a Singapore PR (Singapore Permanent Resident) ? *
Required
How do you get to know ANS? (our iHR Facebook? our iHR ANS Facebook Page? through Sister?/ Brother?/ Cousin?/ Friend/ Senior/ Teacher?) . Have you contacted anyone else to apply this ANS? What is their name? *
Any sibling is applying or currently in ANS? *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy