CONFIDENTIAL

APPLICATION FOR
NATIONAL YOUTH FORUM 2010
Note:
(i) Only Singapore Citizens / Permanent Residents may apply
(ii) * Please delete where necessary

SECTION 1 - PERSONAL PARTICULARS

Affix recent
Name as in NRIC/Passport/PR* (underline surname)* Chinese Characters
passport size
Mr/Mrs/Miss/ Mdm (if applicable)
photograph or
attach a soft copy
here
Home Address Home Tel No.

Handphone No.

Name and Address of Employer Office Tel No. Medical Condition

(if any)

Designation/Occupation NRIC/Passport/PR No.

Nationality Email

Country of Birth Date of Birth Dietary Restrictions Medications currently

being used

Race Marital Status

SECTION 2 - INVOLVEMENT IN NOMINATING ORGANISATION [For Applicants nominated by an Organisation]

Name and Address of Nominating Organisation Duration of Involvement

Positions Held (in chronological order)

Nominee's main Area(s) of Involvement in Nominating Organisation (not more than 30 words)

SECTION 3 - KNOWLEDGE OF LANGUAGES AND DIALECTS

Written & Spoken Written Spoken

Completed form to be mailed/faxed to National Youth Council (Recruitment for NYF 2010)
SCAPE Youth Centre, 113 Somerset Road Singapore 238165
Fax: 6735 4568 Tel: 6309 4077
 CONFIDENTIAL

SECTION 4 - BACKGROUND ACTIVITIES OF NOMINEE (in chronological order)

Extra-Curricular Activities Period of Involvement

Details of membership with positions held in clubs, associations or societies other than nominating organisation (please
state period of involvement)

Details of past participation in local volunteering/ community projects and/or overseas youth exchange programmes etc
(please state year)

SECTION 5 - EDUCATIONAL BACKGROUND (in chronological order)

Schools/Institutions and Country Highest Standard Passed Year

Other Professional Qualifications

Type and Duration of Awards/Scholarships Held

SECTION 6 - EMERGENCY CONTACT

Name Relationship to Nominee Contact Number

SECTION 7 - OTHER INFORMATION

We know not everyone expresses him/ herself best in writing, so we have provided five ways that you may
do so! Just pick one of the following:

1. Write a one page essay

2. Design an art piece with a short description on it
3. Film an original video clip (maximum of 2 minute duration) – (Maximum 50 MB in wmv or avi format)
4. Take an artistic photograph with a short description on it – (Maximum 10 MB in jpeg format)
5. Write a short poem
6. Compose a 2-minute song

(Please do not exceed 200 words for the essay, poem and art piece description. Kindly submit your expression on separate sheets
and in size 12, Font Times New Roman, single spacing)

Completed form to be mailed/faxed to National Youth Council (Recruitment for NYF 2010)
SCAPE Youth Centre, 113 Somerset Road Singapore 238165
Fax: 6735 4568 Tel: 6309 4077
 CONFIDENTIAL

How do you think you can contribute to NYF 2010?

What do you hope to gain/learn from participating in NYF 2010?

During his address at the Marina Parade National Day Dinner, Senior Minister Goh Chok Tong proposed his
version of the Singapore dream by changing the conventional 5Cs to reflect that of the future of Singapore.
He shared his re-invention of the 5Cs to stand for Career, Comfort, Children, Consideration and Charity.
Inspired by his speech, we will be grouping participants into our slightly modified version of the 5Cs,
namely Career, Children, Consideration/Charity, Comfort and Culture. Please indicate your preferred group
in the areas provided in the box below.

Area of Interest Please rank your Please highlight any special knowledge/skills or training in
choices (1st choice the area
to 5th choice)
Career
Children
Consideration/Charity
Culture
Comfort
What are your thoughts on his proposed re-invention of the 5Cs?
Select one (or more) of the Cs and share your views in 200 words or less.

SECTION 8 - NOMINATOR'S COMMENTS [For Applicants nominated by an Organisation]

Comments on Nominee

Name of Nominator Tel (O) :

Fax :
Email:
Position in Organisation Stamp of Nominating Organisation

Signature of Nominator Date

SECTION 9 - CHARACTER REFEREES (Please provide particulars of two persons who are not related to you.
They should be responsible persons who know you well with regard to your character and voluntary work.
PA/NYC may contact the referees stated.)
Name of Referee (1) Name of Referee (2)

Address Address

Email Address Email Address

Completed form to be mailed/faxed to National Youth Council (Recruitment for NYF 2010)
SCAPE Youth Centre, 113 Somerset Road Singapore 238165
Fax: 6735 4568 Tel: 6309 4077
 CONFIDENTIAL

Contact No. Contact No

Occupation Years Known Occupation Years Known

SECTION 10 - MISCELLANEOUS

1 Have you suffered, or are suffering from any medical condition, illness, * Yes/No
disease, mental illness or physical impairment?

2a. Do you have a criminal record¹ in Singapore? * Yes/No

b. Have you ever been convicted of a criminal offence in a court of law in any * Yes/No
other country? (excluding criminal records disclosed above)

3 Have you been charged with any criminal offence in a court of law in any * Yes/No
country for which the outcome is pending?

4 Have you ever been declared a bankrupt? * Yes/No

SECTION 11 - DECLARATION

(1) I give my consent for the relevant Government authorities to obtain and verify information from or with any source,
as you deem appropriate for the assessment of my participation with National Youth Forum.

(2) I give my consent for PA/NYC/NYF to communicate with me with regard to its youth programmes and activities by
electronic mail or any other means which PA/NYC/NYF may deem appropriate at my contact details set out in this
form.

(3) I understand that PA/NYC/NYF reserves the rights to use all my works and submissions, event photos and NYF
photos and any other documents, but not limited to publicity and publication purposes.

(4) I declare that the particulars in this form are true to the best of my knowledge and I have not wilfully suppressed any
material fact. I accept that if any of information given by me in this application is in any way false or incorrect, my
service with NYC will be terminated without any notice.

Date
Signature of Applicant

PARENTAL CONSENT (for applicants under 21 years old)

Parent / Guardian, please read, sign and date the following:

I hereby certify that the information given by the applicant is true and correct. I agree that I will not hold the Organisers
liable for any injury, loss or damage that my child may suffer or sustain in the course of or in connection with his/her
participation as a volunteer.

Signature of Parent Date

Completed form to be mailed/faxed to National Youth Council (Recruitment for NYF 2010)
SCAPE Youth Centre, 113 Somerset Road Singapore 238165
Fax: 6735 4568 Tel: 6309 4077