WDA HEALTHCARE SCHOLARSHIP APPLICATION FORM (2015) ABOUT THE WDA HEALTHCARE SCHOLARSHIP 1. Objective: The WDA Healthcare Scholarship is developed to empower healthcare professionals to progress in their careers and assume leadership positions. It is also open to mid-career switchers who wish to make a contribution in the healthcare and community and social services sector. 2. Course List & Bond Period: Course Institution Bond Period Graduate Diploma in Healthcare Management and Leadership Singapore Management UniversitySingHealth 1 year Master of Health Administration Flinders University, Australia (in partnership with Parkway College) 1 year Master of Public Health National University of Singapore Graduate Diploma of Gerontology SIM University 1 year Master of Gerontology SIM University 1 year Master of Science (Speech and Language Pathology)2 National University of Singapore 3 years Master of Science (Audiology) National University of Singapore 3 years Master of Psychology (Clinical) National University of Singapore 3 years Master of Counselling SIM University 1 year Master of Social Work SIM University 1 year 1 – 3 years1 Bond period: Both medically qualified full-time and non-medically qualified full-time – 3 years; Both medically qualified part-time and non-medically qualified part-time – 1 year. 2 Master of Science (Speech and Language Pathology) is not applicable for 2015. 1 1 Updated as of 17 March 2015 3. Who Can Apply: Employees currently working in restructured hospitals, community hospitals, private acute hospitals and ILTC institutions, MOH-registered eldercare institutions, primary healthcare institutions and MSF-supported social services. Career switchers from other industries will need to source and secure employer sponsorship in order to qualify. 4. Eligibility Criteria: Career Switchers* In-service Upgraders i. ii. iii. iv. v. vi. Singapore Citizen Meet entry requirements of the selected courses Candidate is prepared to serve a bond period ranging from 1 to 3 years (depending on course) upon completion of training Candidate is not currently on any scholarship or serving any bond with WDA or any other organization At least 5 years working experience in the industry and at least 2 years with sponsoring employer At least 2 years working experience Identified as high potential employees Secure employer sponsorship (*) Career Switcher category is only applicable for the Master of Science (Audiology). 5. Funding Mechanism: a. Candidates are to be nominated by their employers (reporting officer and CEO/ED/MD/HOD). b. WDA will sign letters of offer with successful organization applicants. Funding will be disbursed directly to employers. 6. Funding Components and Rates: Component Funding Rate Course Fee Grant** 90% of course fee (Graduate Diploma courses capped at $20,000, Master courses capped at $50,000) Up to 70% of last drawn monthly salary, capped at $3,000 per month. [A further cap of 12 months is applicable for the Master of Public Health] One-time grant of $2,000 per scholar Training Stipend (for full time courses only) Misc Fee (Registration Fee, Book Allowance etc) Maximum of $100,000 per scholar (**) Sponsoring employer pays the remaining course fee. 7. Other funding terms and conditions: Any taxes (e.g. Goods and Services Tax) as imposed by the Government of Singapore on the above fundable components will not be borne by WDA. The above funding rates and caps are subject to WDA’s prevailing corporate funding policies. WDA reserves the right to revise the rates and caps at any point. 2 Updated as of 17 March 2015 INSTRUCTIONS TO EMPLOYER 1. Incomplete or illegible applications may be rejected. Form A is to be completed and signed by a member of the management team. 2. Any false particulars given or wilful suppression of material fact will disqualify this application / scholarship award. 3. The candidate may select up to 3 courses in the application form. Please rank these choices in order of preference if more than one course is selected. 4. Please attach the following documents to this submission: a. Curriculum vitae of nominated employee b. Employment contract / Conditional employment contract (for career switchers) c. A copy of the NRIC (front and back) d. Completed Form A and Form B 5. Please use separate forms if you are nominating more than 1 employee. 6 Please email completed forms and supplementary documents to wda_healthcare@wda.gov.sg AND send them by post to: Singapore Workforce Development Agency 1 Marina Boulevard, #16-01 One Marina Boulevard Singapore 018989 Attn: Mr. Julian Quek (HSBD) 8. Closing date: 30 April 2015 *** *** 3 Updated as of 17 March 2015 (blank page) 4 Updated as of 17 March 2015 Form A EMPLOYER NOMINATION FORM (TO BE COMPLETED BY EMPLOYER) (A) GRADUATE DIPLOMA / MASTER COURSES SUPPORTED UNDER THE WDA HEALTHCARE SCHOLARSHIP Please put up to 3 ticks to indicate the course(s) the candidate wishes to apply for under this Scholarship. Rank your choices (if any) in order of preference, 1 being the most preferred and 3 being the least preferred. Course Institution Next Intake Bond Period Graduate Diploma in Healthcare Management and Leadership Singapore Management University-SingHealth Jul 2015 1 year Master of Health Administration Flinders University, Australia (in partnership with Parkway College) Jun 2015 1 year Master of Public Health National University of Singapore Aug 2015 1–3 years3 Graduate Diploma of Gerontology SIM University Jul 2015 1 year Master of Gerontology SIM University Jul 2015 1 year Master of Science (Speech and Language Pathology)4 National University of Singapore Jan 2017 3 years Master of Science (Audiology) National University of Singapore Aug 2015 3 years Master of Psychology (Clinical) National University of Singapore Aug 2015 3 years Master of Counselling SIM University Jan 2016 1 year Master of Social Work SIM University Jan 2016 1 year Have you or your nominated staff made any enrolment application(s) to the course(s) of choice? Rank of choice Yes Bond period: Both medically qualified full-time and non-medically qualified full-time – 3 years; Both medically qualified part-time and non-medically qualified part-time – 1 year 4 Master of Science (Speech and Language Pathology) is not applicable for 2015. 3 A-1 Updated as of 17 March 2015 No Form A (B) EMPLOYER’S DETAILS 1. Name of organisation: 2. Type of industry: 3. Name of CEO / ED / MD / HOD*: 4. Email address of CEO / ED / MD / HOD*: 5. Name and Designation of Reporting Officer: 6. Email address and contact no. of Reporting Officer: * Please delete as appropriate. (C) EMPLOYEE’S DETAILS 1. Full Name : 4. NRIC No. (PINK): 2. Designation : 5. Department: 3. Years of service with current employer: (D) EMPLOYEE’S JOB SCOPE Please answer the following questions about the nominated employee. Delete responses as appropriate. 1. For in-service staff: Does your nominated staff have at least 5 years of experience in the healthcare sector, of which at least 2 years are with your organisation? For career switchers: Does your nominated staff have at least 2 years of working experience? Yes No 2. Does he/she meet the entry requirement of the selected course(s)? Yes No 3. Is he/she prepared to serve a bond with your organisation upon completion of training? Yes No 4. Is he/she currently on any other scholarship or serving any bond with any organisation? Yes No 5. a. (In-service upgrader candidates only) Does he/she currently have any managerial responsibilities? If yes, please elaborate: Yes No A-2 Updated as of 17 March 2015 Form A b. (Mid-career switcher candidates only) Please share briefly why the candidate has been identified as a potential hire. 6. Is he/she identified and being groomed for a higher level position? If yes, please explain and describe your organisation’s development plan for this staff. 7. Is your organisation willing to participate in WDA’s outcome evaluation / tracking survey to ascertain the effective of this programme? 8. What were his/her current and past performance grades? Please indicate in the boxes to the right for years 2012-2014. (Not applicable to career switchers) 9. What is the most significant achievement or contribution of this staff in recent years? Please elaborate: (Not applicable to career switchers) 10. Please state and elaborate any other reasons for nominating this staff. Please be as detailed as possible. A-3 Yes No Yes No 2012 2013 2014 Updated as of 17 March 2015 Form A (E) DECLARATION We, the undersigned, declare that the information given above is true to the best of our knowledge and have not wilfully distorted or suppressed any material fact. We accept that if any of the information given by us in this application is found to be false, misleading or incorrect, this application may be disqualified and WDA may at its discretion, withdraw the scholarship award and recover immediately from us any grant that may have been disbursed to our organisation. Nominated by (Reporting Officer): Name and designation Signature Date Name and designation Signature Date Endorsed by (CEO/ED/MD/HOD): Company Stamp: A-4 Updated as of 17 March 2015 Form B NOMINATED EMPLOYEE FORM (TO BE COMPLETED BY EMPLOYEE) (A) PERSONAL PARTICULARS 1. Full Name : 4. Designation: 2. NRIC (PINK) : 5. Email Address : 6. Tel : 3. Address : (O) / (HP) 7. Date of Birth : 8. Sex : *M / F * Please delete as appropriate. (B) EDUCATIONAL QUALIFICATIONS i) University Degree(s) / Diploma (s) Name of Institution Period of Study (MMYY to MMYY) Highest Level of Qualification Obtained ii) *GCE 'A' Level / GCE 'A' Level Equivalent Name of Institution: Period of Study (MMYY to MMYY): Subject Grade Subject Grade * Please delete as appropriate. (C) SCHOLARSHIPS & AWARDS Sponsoring Organisation Duration of Bond From (year) B-1 To (year) Name of Scholarships/Awards (including PSC awards) Updated as of 17 March 2015 Form B (D) PROFESSIONAL QUALIFICATIONS & MEMBERSHIPS/OTHER EDUCATIONAL CERTIFICATES OR TRAINING UNDERTAKEN OR CURRENTLY PURSUING, OTHER AWARDS, MEDALS & PRIZES Year (E) Description PAST PROFESSIONAL EXPERIENCE Please provide information of your employment history. The details should be found in your CV. Total number of years of full-time working experience : Organisation Name (F) Period of Employment (MMYY – MMYY) Job Title LANGUAGE PROFICIENCY Please indicate the languages that you are proficient in, and indicate your proficiency with Poor, Average or Good. Language Proficiency Written (G) Spoken OTHER SKILLS AND PROFICIENCIES Skill Proficiency B-2 Updated as of 17 March 2015 Form B (H) REFEREES Please indicate 2 referees who are not from your organisation. WDA may contact these referees in the evaluation of your application. Full Name (I) Occupation Organization Contact Years Known Email DECLARATION Please answer the following questions with a tick in the appropriate box. 1. Have you ever suffered, or are suffering from any medical condition, illness, disease, mental illness or physical impairment? Yes No Yes No 3. Have you ever been convicted in a court of law in any other country (excluding parking offences or criminal records disclosed above)? Yes No 4. Have you been charged with any offence in a court of law in Singapore or in any other country for which the outcome is pending (excluding parking offences)? Yes No Yes No Yes No Yes No 2. Do you have a criminal record in Singapore or in other countries? 5. Have you been or are you under any financial embarrassment i.e. (a) an undischarged bankrupt, (b) a judgment debtor, (c) have unsecured debts and liabilities of more than 3 months of last drawn pay, (d) have signed a promissory note or an acknowledgement of indebtedness? 6. Do you currently have any obligations to any organisation(s) in terms of bond, study loans, scholarships, etc? 7. Have you previously broken any bond? 8. If you answered ‘Yes’ to any of the questions above, please provide details here: ______________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ I declare that the information given in this application form is true to the best of my knowledge and have not wilfully distorted or suppressed any material fact. I accept that if any of the information given by me in this application is false, misleading or incorrect, I may be disqualified from this scholarship and may be liable to pay liquidated damages. ________________________ Signature of applicant ________________________ Date B-3 Updated as of 17 March 2015