International Relations Office
This award was created in 2003 through a generous donation from the Lee Foundation to help fund NUS students on exchange to University of British Columbia (UBC)
1. Please read through the eligibility requirements and terms and conditions of the Award in
Annex A before completing and submitting the application.
2. Incomplete, illegible and late applications will not be considered.
3. Duly completed application forms and supporting documents must be submitted to your
Dean’s Office, c/o the Student Exchange Program (SEP) Administrator/Coordinator in charge of collating applications for this Award. Please check with the SEP
Administrator/Coordinator in your faculty/school for their application deadline.
4. The SEP Administrator/Coordinator will collate all applications and submit them to the
International Relations Office by the closing date of 15 April 2014.
5. Approval of application will be subject to the terms and conditions specified in Annex A and any additional comments stated herein. NUS may, at any time, revise the terms and conditions of the Award at its sole and absolute discretion.
6. For further enquiries on the Award, please contact the International Relations Office at http://nus.edu.sg/iro/home/contact.html
.
Please attach a most recent photograph
Name (Please underline Family Name): NRIC/Passport No.: Gender: Male / Female #
Matriculation No.: Nationality: Faculty / School and Department:
Residential Address:
Mailing Address (if different from above):
Home Tel:
Mobile:
Date of Birth:
Ethnicity:
NUS e-mail address:
Other e-mail address:
Please list the countries which you have visited for:
Holidays:
Others:
3rd Storey, Unit 03-03, Shaw Foundation Alumni House, 11 Kent Ridge Drive, Singapore 119244
Website: www.nus.edu.sg/iro

NUS-UBC Lee Foundation Student Exchange Award AY 2014/2015
Names of Parent(s)/ Guardian(s)/ Next of Kin
Number of family members:
Residential Address of Parent/ Guardian/
Next of Kin # :
Mailing Address (if different from above):
# : Relationship:
Number of Siblings:
Office Tel:
Home Tel:
Mobile:
Total Annual Household Income (of family members who are financially supporting the applicant in S$):
Number of family members supported by this income:
Occupation:
Designation:
Employer:
Please list down and attach all income statement documents of all family members who are financially supporting the applicant
. These documents are required to assess your family’s Total Annual Household Income (all family members who are financially supporting the applicant:
A copy of income tax assessments statements (This statement or a relevant substitute must be provided)
A copy of IR8A form (This form or a relevant substitute must be provided)
A copy of the most recent pay slip (This must be provided)
_________________________________________________________________
_________________________________________________________
B. ACADEMIC AND FINANCIAL AWARDS
Please list the awards that you have received over the last two years in chronological order and provide copies of documentary evidence. For scholarship holders, please produce a letter of approval from your scholarship provider(s) on receiving this award, if you are successful. The letter must also indicate the amount of financial support rendered (if any) for your intended SEP at the University of British Columbia (UBC).
Year Type of Award (For scholarships and awards, please indicate the tenure and value of award)
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NUS-UBC Lee Foundation Student Exchange Award AY 2014/2015
C. CO-CURRICULAR ACTIVITIES
(Please list the activities that you have participated in NUS together with your CCA records)
Date/Duration Brief Description of Activities Title/Role (eg. President, Secretary, etc)
D. PERIOD OF STUDY FOR THE AWARD (Please tick the appropriate box)
NUS Semester 1 / UBC Fall term (Sep to Dec)
__________ to _________, AY 2014/15
NUS Semester 2 / UBC Spring Term (Jan to Apr)
E. INTEREST IN THE STUDENT EXCHANGE PROGRAMME AT UBC AND THE AWARD
Please attach an essay, of a maximum of 500 words, about your interest in this award and how you plan to benefit from your student exchange stint at UBC. Please note that this essay forms an important part of your application.
F. FACULTY RECOMMENDATION
Please attach a Letter of Support from the Dean or Recommendation Letter from a faculty member.
G. ACADEMIC RECORDS
Please attach the NUS results slips for all completed semesters.
H
. APPLICANT’S DECLARATION AND UNDERTAKINGS
I hereby declare/undertake that: a) All information provided is true, complete and accurate to the best of my belief and knowledge, and that I have not wilfully suppressed any material fact; b) I have also satisfied ALL eligibility criteria for the Student Exchange Programme (SEP); c) I am medically fit and free from any medical problems which may impair my ability to participate in the SEP at the University of British Columbia (UBC) ; d) I accept that I may be unsuccessful in my application without any reason being given; e) I will abide by such terms and conditions as may be stipulated by NUS in respect of this Award, if I am selected; f) I understand that, if for any reason, my exchange at UBC is terminated or withdrawn, I will no longer be eligible for the Award and will undertake to return all monies drawn (if any) to the NUS International Relations Office;
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NUS-UBC Lee Foundation Student Exchange Award AY 2014/2015 g) Within six weeks from the end of the UBC semester, I will provide a concise report (2 to 3 pages with photographs) on my exchange experience at UBC and how I have benefited from it; h) Within six weeks from the end of the UBC semester, I will provide a personal letter of appreciation to the Lee
Foundation for this Award; i) Where requested and appropriate, I will also participate in or attend any award ceremony, appreciation or publicity event in relation to the Award or SEP; j) I will not hold NUS, its officers, or any of its full time or part time staff (including student assistants) responsible or liable in any way for, and that no right of action shall arise from, any loss or damage (including, without limitation, personal injury or property damage) caused by or sustained as a result of my participation in the SEP, whether through: (i) neglect on the part of the University, its officers or any of its full time or part time staff (including student assistants); or (ii) otherwise; k) I will indemnify NUS and keep NUS indemnified against all losses, claims, demands, actions, proceedings, damages, costs, expenses, and any other liability arising in any way from my participation in the SEP or any breach of my undertakings hereof; and l) I fully understand that if I fail to comply with the terms and conditions of the SEP and/or if any of the above declarations are found to be untrue, the Award may be withdrawn and I will be required to depart from UBC at my own expense.
Name of Applicant Signature of Applicant
_______________________ _________________________
Date
Name of Witness
(Must be a representative from the
Dean’s Office)
_________________________
_________________________ Signature of Witness _______________________
_________________________ Date
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NUS-UBC Lee Foundation Student Exchange Award AY 2014/2015
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NUS-UBC Lee Foundation Student Exchange Award AY 2014/2015
1. Eligibility Criteria

Applicants must be nominated for the Student Exchange Program (SEP) for AY 2014/2015 at University of
British Columbia (UBC) by their faculty/school before they can apply for this Award.

Applicants must fulfill all eligibility criteria for SEP.

It is the responsibility of the scholarship holders to produce an official letter of approval from their scholarship providers on receiving this award, if they are successful. The letter must also indicate clearly the amount of financial support that will be rendered by the scholarship provider for the applicant’s intended exchange.
2. Quantum of Awards

The amount awarded varies from year to year and helps to offset the cost of airfare, accommodation and living expenses.

Each successful applicant will be given one award, regardless of whether he/she goes on exchange for one semester or one academic year.
3. Terms and Conditions

Recipients must be medically fit for the intended SEP.

Recipients must abide by the terms and conditions as stipulated by NUS in respect of this Award. NUS reserves the right to revise the terms and conditions, including the quantum and eligibility criteria, of this award at its sole discretion.

Recipients understand and undertake that should their exchange at UBC be terminated or withdrawn, whether at the beginning or mid-way, they will no longer be eligible for the award and will return all monies drawn (if any) to NUS International Relations Office.

Within six weeks from the end of the UBC semester, recipients should furnish the NUS International
Relations Office with the following: a) A concise report (2 to 3 pages with photographs) on his/her exchange experience and how they have benefited from it; b) A personal letter of appreciation to the Lee Foundation for the Award.

Where required and appropriate, recipients should also attend or participate in any award ceremony, appreciation or publicity event in relation to the Award or SEP.
4. Supporting Documents Required with Application
Application forms must be duly completed and accompanied with the following supporting documents:

Copies of income tax assessments statements (or relevant substitute), IR8A form (or relevant substitute), and most recent pay slip, of all family members who are financially supporting the applicant;

CCA records, if applicable;

Essay, of a maximum of 500 words, about your interest in this award and how you plan to benefit from your student exchange stint at UBC;

Letter of Support from the Dean or Recommendation Letter from a faculty member who has taught the applicant;

NUS results slips.
5. Selection

Selection will be done by a Selection Committee and successful applicants will be notified.
6. Supporting Documents Required Before Confirmation and Disbursement of the Award
 A copy of the official letter from NUS Registrar’s Office confirming the applicant’s participation in SEP to
UBC

A copy of the official acceptance letter from UBC
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