click here for the form
3. Once an application is submitted, any request for a change of programme will not be accepted. For those who
wish to change programme, a new application fee will be imposed. Please write to study@sim.edu.sg to withdraw your application before re-submitting a fresh application.
Page 6. 17 January
Important Instructions
Application for admission to:
MASTER OF SCIENCE INTERNATIONAL
HEALTHCARE LEADERSHIP
Important: Tick accordingly and fill in the year of intake
Part-time Programme
Master of Science International Healthcare Leadership
Programme Code
MIHLP
Month of Intake
March
Year of Intake
2019
Note: The programme is open to local and international applicants.
Important Instructions
Important Instructions:
1. Complete and submit the application form, together with copies of all certificates, detailed result transcripts, NRIC/Passport, application fees to SIM’s Student Recruitment Office located at SIM Headquarters (Block A, Level 2). All fees and copies of documents submitted with the application form will not be returned to applicant. ORIGINAL(S) of all supporting documents have to be presented for verification at SIM’s Student Recruitment Office. For any documents that are not in English language, please provide an original translated and notarised version.
2. Applications WITHOUT complete information or supporting documents or application fee will not be considered. Any data with illegible writing will be considered as incomplete information.
3. Once an application is submitted, any request for a change of programme will not be accepted. For those who
wish to change programme, a new application fee will be imposed. Please write to study@sim.edu.sg to withdraw your application before re-submitting a fresh application.
Singapore Institute of Management Pte Ltd, SIM Headquarters, 461 Clementi Road, Singapore 599491
Tel: +65 6248 9746 | Website: www.simge.edu.sg
1a Personal Details
Title: *Mr/Mrs/Ms/Mdm/Dr Family Name / Surname: ________________________________________________________________________________
Full Name: ___________________________________________________________________________________________________________________________
As it appears in your NRIC (local)/Passport (international). Your full name will be used for student registration, degree certificates, transcripts and all correspondence.
NRIC/Passport No: ___________________________________________ International Applicants must provide FIN: _______________________________
(For Singaporeans and Malaysians, please specify NRIC No. For others, please enter Passport No.) (Where applicable)
Date of Birth: ____________________________ Gender: Male Female Marital Status: Single Married Others ____________
(dd/mm/yyyy)
Race: Chinese Malay Indian Others_____________________________________________________
Nationality: Singaporean Malaysian Others ___________________________________________________________________
Singapore Address: ___________________________________________________________________________________________________________________
______________________________________________________________________________________ Postal Code: ___________________________________
Home Country Address (For International Applicants Only): ______________________________________________________________________________
______________________________________________________________________________________ Country: _______________________________________
Preferred Mailing Address: Singapore Address Home Country Address
Contact No: Singapore ___________________________ Home Country __________________________ Mobile Phone ___________________________
E-mail Address: _______________________________________________________________________________________________________________________
For International Applicants only: Permanent Resident Employment Pass / Work Permit Dependant Pass
Professional Pass Student’s Pass Others _______________________________________
State the expiry date of your indicated Pass: __________________________________
(dd/mm/yyyy)
National Service Status: *Currently Serving/Regular/Contract Completed Full-time Exempted Not Enlisted Yet Not Applicable
From: ____________________________to____________________________ (ORD) Total years served: ____________ Rank: _______________________
(dd/mm/yyyy) (dd/mm/yyyy)
Part-time Programme Programme Code
Month of
Intake
Year of Intake
Master of Science International Healthcare
Leadership
MIHLP March
Note: The programme is open to local and international applicants.
Singapore Institute of Management Pte Ltd, SIM Headquarters, 461 Clementi Road, Singapore 599491
Tel: +65 6248 9746 | Website: www.simge.edu.sg
Important Instructions
1. Complete and submit the application form, together with copies of all certificates, detailed result transcripts, NRIC/Passport, application fees to SIM’s Student Recruitment Office located at SIM Headquarters (Block A, Level 2). All fees and copies of documents submitted with the application form will not be returned to applicant. ORIGINAL(S) of all supporting
documents have to be presented for verification at SIM’s Student Recruitment Office. For any documents that are not in English language, please provide an original translated and notarised version.
2. Applications WITHOUT complete information or supporting documents or application fee will not be considered. Any data with illegible writing will be considered as incomplete information.
3. Once an application is submitted, any request for a change of programme will not be accepted. For those who wish to change programme, a new application fee will be imposed.
Please write to study@sim.edu.sg to withdraw your application before re-submitting a fresh application
Application for admission to:
MASTER OF SCIENCE INTERNATIONAL
HEALTHCARE LEADERSHIP
Important: Tick accordingly and fill in the year of intake
1. Deg Cert 3. Transcript 5. GCE ‘O’ 7. Photos
2. Dip Cert 4. GCE ‘A’’ 6. NRIC / Passport
Page 2 19 1Se7p Jtaenmubareyr 22001187
Page 2
____________________________________________________
From to
(dd/mm/yyyy) (dd/mm/yyyy)
Class of Degree:____________________________________
____________________________________________________
From to
(dd/mm/yyyy) (dd/mm/yyyy)
____________________________________________________
From to
(dd/mm/yyyy) (dd/mm/yyyy)
____________________________________________________
From to
(dd/mm/yyyy) (dd/mm/yyyy)
3 Present Employment Details
Company Name: ____________________________________________________________________________________________________________________
Company Address: __________________________________________________________________________________________________________________
_________________________________________________________________________________ Postal Code: ______________________________________
Office Contact No: _______________________________________________________________ Department: ______________________________________
Current Designation: ________________________________________________________________________________________________________________
No of years in this position: From: Number of staff reporting directly to you: __________________
(dd/mm/yyyy)
1b In Case of Emergency
Full Name: (*Mr/Mrs/Ms/Mdm/Dr) _________________________________________________________________________________________________________
Relationship to Applicant: _________________________________________________________________________________________________________________
Contact No: Home _______________________________________ Mobile Phone _____________________________________
E-mail Address: ______________________________________________________
If address is not the same as in Section 1a, please indicate below:
Address: __________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________ Country: _______________________________
2 Education Qualification Details
2a) Qualification Details
Qualification Qualification Title Awarding Institution
Study
Mode*
Year
Awarded
Degree FT / PT
Diploma
(Polytechnic) FT / PT
Others:
_______________
_______________
FT / PT
Others:
_______________
_______________
FT / PT
* FT = Full-time; PT = Part-time; delete where appropriate
2b) English Proficiency
GCE ‘O’ Level
(Taken as First
Language)
Date awarded Grade Obtained: _______
IELTS Date awarded Total Score: _______ (Sub test: 1: _____ 2: _____ 3: _____ 4: _____ )
Note: The IELTS certificate is valid for two years only.
I will be taking the IELTS on and the results will be released on
(dd/mm/yyyy) (dd/mm/yyyy)
I will send a copy of the results to SIM Headquarters.
____________________________________________________
From to
(dd/mm/yyyy) (dd/mm/yyyy)
Class of Degree:____________________________________
____________________________________________________
From to
(dd/mm/yyyy) (dd/mm/yyyy)
____________________________________________________
From to
(dd/mm/yyyy) (dd/mm/yyyy)
____________________________________________________
From to
(dd/mm/yyyy) (dd/mm/yyyy)
3 Present Employment Details
Company Name: ____________________________________________________________________________________________________________________
1b In Case of Emergency
Full Name: (*Mr/Mrs/Ms/Mdm/Dr) _________________________________________________________________________________________________________
Relationship to Applicant: _________________________________________________________________________________________________________________
Contact No: Home _______________________________________ Mobile Phone _____________________________________
E-mail Address: ______________________________________________________
If address is not the same as in Section 1a, please indicate below:
Address: __________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________ Country: _______________________________
2 Education Qualification Details
2a) Qualification Details
Qualification Qualification Title Awarding Institution
Study
Mode*
Year
Awarded
Degree FT / PT
Diploma
(Polytechnic) FT / PT
Others:
_______________
_______________
FT / PT
Others:
_______________
_______________
FT / PT
* FT = Full-time; PT = Part-time; delete where appropriate
2b) English Proficiency
GCE ‘O’ Level
(Taken as First
Language)
Date awarded Grade Obtained: _______
IELTS Date awarded Total Score: _______ (Sub test: 1: _____ 2: _____ 3: _____ 4: _____ )
Note: The IELTS certificate is valid for two years only.
I will be taking the IELTS on and the results will be released on
(dd/mm/yyyy) (dd/mm/yyyy)
I will send a copy of the results to SIM Headquarters.
1c Next of Kin (For international applicants only)
Full Name: (*Mr/Mrs/Ms/Mdm/Dr):
Relationship to Applicant:
Indicate below if contact details of parent or guardian is not the same as given under 1b.
Mailing Address:
Country:
Telephone: Home Mobile Phone Fax
E-mail Address:
Page 3 17 January 2018
4 Past Employment Record
5 References
In chronological sequence, start with your current position followed by past positions held. Please ensure that all details pertaining
to your past appointments are correctly provided.
Name of Company Designation
Period
a)
b)
c)
d)
e)
From
mth/yr
To
mth/yr
No
of Years/
Months
Job Description
(Responsibilities &
Nature of work)
No. of
staff reporting
directly to you
Please name two references
Your application cannot be considered until your references have been received including, at least one academic. Please list below the names
and details of 2 referees who are able to comment on your suitability for the programme. Enclose one copy of a reference letter from each
of them. Any delay in receipt of references will mean that consideration of your application will also be delayed.
Referee 1
Name:
Position:
Tel:
Email:
Name:
Position:
Tel:
Email:
Referee 2
7 Disability Statement
The University welcomes applications from prospects with additional support needs as a result of a disability, medical condition
or specific language difficulty. All applications will be considered under the same criteria as other applications. It is important that
we are aware of any additional support needs in advance so that we can discuss whether facilities are available in the University.
Please tick to indicate if you suffer from any disability or illness, which might affect your studies? Yes No
I give consent for this information to be shared with the University’s Disability Advisory and Support Service.
6 Statement of Purpose
Note: All applicants must complete this section.
Please attach a separate, succinct one-page statement to describe your purpose and objectives in undertaking this MSc programme.
Describe your career aspirations and how you expect the MSc to help you achieve them.
19 September 2017
Page 2
3 Present Employment Details
Company Name: ____________________________________________________________________________________________________________________
Company Address: __________________________________________________________________________________________________________________
_________________________________________________________________________________ Postal Code: ______________________________________
Office Contact No: _______________________________________________________________ Department: ______________________________________
Current Designation: ________________________________________________________________________________________________________________
No of years in this position: From: Number of staff reporting directly to you: __________________
(dd/mm/yyyy)
I will send a copy of the results to SIM Headquarters.
Page 4 17 January 2018
a) Company Sponsorship
The company is sponsoring the applicant for:
Course Fee Yes No
(If yes, please attach the official letter from your company with this application form)
b) Company Certification
We certify that all statements made on this application form are true and complete to the best of our knowledge. We agree that any
misrepresentation or omission is sufficient grounds for the rejection of the application. We also authorise any investigation upon the
information provided for verification purposes. If admitted into the programme, the applicant will not be asked to absent himself/
herself from lectures except for urgent assignments.
Contact No of Authorised Company Officer
Company Stamp
Name and Designation of Authorised Company Officer
Signature and Date
8 To be completed by the Company (for Company-sponsored applicants only)
9 Key points to note
To help you confirm that you have gathered sufficient information on your choice of study, we have prepared a checklist of key points for you
to take note of. Kindly ensure that you understand the details relating to the points listed below before submitting your application. The information
can be found in our brochure/website. If you have any queries, please do not hesitate to contact our Programme Counsellors/Agents who would
be happy to assist you.
1. Application fee and procedures
2. Course admission and English Language proficiency requirements and exemptions
3. Course modules, outlines, assessment and learning outcomes
4. Total fee payable for the entire course duration
5. Course duration and assessment schedules
6. Progression and award criteria
7. Type of certification awarded at the end of the course
8. Opportunities for further education or job prospects after graduation
9. Successful applicants are required to accept the offer and PEI-Student Contract
10. Fee Protection Scheme adopted by SIM PL and the payment methods/schedule
11. SIM PL Medical Insurance
12. Refund, transfer and withdrawal policies
13. Venue of studies and a general description of the facilities and infrastructure
14. Types of student support services, e.g. Student Services and Student Life
For National Service-liable Applicants:
15. Under the Enlistment Act, Singapore Citizens and Permanent Residents will be enlisted for the National Service (NS) at the earliest
opportunity upon reaching 18 years old. If you are liable for NS, you are advised to seek deferment from the Central Manpower Base
(CMPB) before commencing your studies. Please note that failure to seek the necessary approval may result in disruption of your studies
if you are required to enlist for NS.
Additional points for International Applicants to note:
10
16. Visa and student’s pass application requirements and procedures
17. General healthcare services in Singapore
18. Relevant Singapore laws such as Immigration & Checkpoints Authority (ICA) and Ministry of Manpower (MOM) regulations. This
19. Accommodation and cost of living in Singapore
includes the restriction on working or taking up an internship in Singapore without the necessary work pass issued by MOM.
Partner University Specific Declaration
Page 3 19 September 2017
Disability Statement
The University welcomes applications from prospects with additional support needs as a result of a disability, medical condition
or specific language difficulty. All applications will be considered under the same criteria as other applications. It is important that
we are aware of any additional support needs in advance so that we can discuss whether facilities are available in the University.
Please tick to indicate if you suffer from any disability or illness, which might affect your studies? Yes No
I give consent for this information to be shared with the University’s Disability Advisory and Support Service.
Describe your career aspirations and how you expect the MSc to help you achieve them.
a) Company Sponsorship
The company is sponsoring the applicant for:
Course Fee Yes No
(If yes, please attach the official letter from your company with this application form)
b) Company Certification
We certify that all statements made on this application form are true and complete to the best of our knowledge. We agree that any
misrepresentation or omission is sufficient grounds for the rejection of the application. We also authorise any investigation upon the
information provided for verification purposes. If admitted into the programme, the applicant will not be asked to absent himself/
herself from lectures except for urgent assignments.
Contact No of Authorised Company Officer
Company Stamp
Name and Designation of Authorised Company Officer
Signature and Date
8 To be completed by the Company (for Company-sponsored applicants only)
9 Key points to note
To help you confirm that you have gathered sufficient information on your choice of study, we have prepared a checklist of key points for you
to take note of. Kindly ensure that you understand the details relating to the points listed below before submitting your application. The information
can be found in our brochure/website. If you have any queries, please do not hesitate to contact our Programme Counsellors/Agents who would
be happy to assist you.
1. Application fee and procedures
2. Course admission and English Language proficiency requirements and exemptions
3. Course modules, outlines, assessment and learning outcomes
4. Total fee payable for the entire course duration
5. Course duration and assessment schedules
6. Progression and award criteria
7. Type of certification awarded at the end of the course
8. Opportunities for further education or job prospects after graduation
9. Successful applicants are required to accept the offer and PEI-Student Contract
10. Fee Protection Scheme adopted by SIM PL and the payment methods/schedule
11. SIM PL Medical Insurance
12. Refund, transfer and withdrawal policies
13. Venue of studies and a general description of the facilities and infrastructure
14. Types of student support services, e.g. Student Services and Student Life
For National Service-liable Applicants:
15. Under the Enlistment Act, Singapore Citizens and Permanent Residents will be enlisted for the National Service (NS) at the earliest
opportunity upon reaching 18 years old. If you are liable for NS, you are advised to seek deferment from the Central Manpower Base
(CMPB) before commencing your studies. Please note that failure to seek the necessary approval may result in disruption of your studies
if you are required to enlist for NS.
Additional points for International Applicants to note:
10
16. Visa and student’s pass application requirements and procedures
17. General healthcare services in Singapore
18. Relevant Singapore laws such as Immigration & Checkpoints Authority (ICA) and Ministry of Manpower (MOM) regulations. This
19. Accommodation and cost of living in Singapore
includes the restriction on working or taking up an internship in Singapore without the necessary work pass issued by MOM.
Partner University Specific Declaration
7 Applicants with Disability or Special Needs
Page 5 17 January 2018
19 September 2017
Page 4
Additional points for International Applicants to note:
10
As long as I am a registered student at SIM, I permit The University of Manchester to provide information about me to SIM and likewise for SIM
to facilitate my enrolment with the University. (Please refer to The University of Manchester’s Data Collection Notice:
http://documents.manchester.ac.uk/display.aspx?DocID=19049)
I accept the above conditions to my application
16. Visa and student’s pass application requirements and procedures
17. General healthcare services in Singapore
18. Relevant Singapore laws such as Immigration & Checkpoints Authority (ICA) and Ministry of Manpower (MOM) regulations. This
19. Accommodation and cost of living in Singapore
includes the restriction on working or taking up an internship in Singapore without the necessary work pass issued by MOM.
Partner University Specific Declaration
I have been counselled by SIM / SIM Appointed Agents for these information.
I have read sufficient information, and where applicable, I have contacted SIM / SIM Appointed Agents for clarification.
I have read sufficient information on my own and confirm that I do not required any pre-course counselling by SIM / SIM Appointed Agents.
11 Data Confidentiality Clause
SIM PL is committed to maintaining the confidentiality of the student’s personal information and undertakes not to divulge any of the
student’s personal information to any third party without the prior written consent of the student SUBJECT TO the obligation of SIM PL
to disclose to any Singapore government authority any information relating to the student in compliance with the law and/or to the
organisation conferring/awarding the qualification.
By submitting to us this application, you consent to our collection and use of your personal data as well as disclosure of personal
data to our Partner Institution with whom SIM PL collaborates with in offering this programme (if applicable) for the purpose of
processing this application. Additionally, you have agreed to us contacting you via voice call, text message and / or email to share
with you more information about the educational services and matters that may be relevant to your academic pursuit.
The personal data collected in this application is for the provision of education services to our students. Such Education Services
include the processing, administration, management and completion of delivery and conduct of academic and co-curricular
programmes.
For administrative requirements of SIM PL to facilitate your application, and enrolment and continued participation in our academic
and co-curricular programmes (if applicable), SIM PL is required to use and disclose personal data about our students for the following
purposes:
a. to disclose and transfer the student’s personal data to the Partner Institution for the processing of the student’s application
for admission, enrolment and administration of the relevant academic programmes;
b. for SIM PL to disclose to the student, other information as may be necessary to be communicated to the student in connection
with his / her undertaking of the relevant academic programmes at SIM PL and where authorised by the Partner Institution,
his / her examination and assessment results;
c. for the Partner Institution to report, where required, student enrolment details to their State and Federal Government agencies
in the respective jurisdictions, including the relevant departments of education, employment, immigration, citizenship and
taxation office, etc;
d. to enable administration and management by SIM PL of co-curricular programmes that complement the academic programmes
in its provision of holistic education and which may be of interest to the students, such as:
i. internship and career opportunities or development;
ii. student welfare and development;
iii. arts, music, sports, leisure, social or community activities, etc;
e. to enable administration by SIM PL of the academic and co-curricular programmes and management of students’ admission,
enrolment, academic and non-academic records, and other operational affairs of SIM PL as an educational institution registered
with the Singapore Committee for Private Education (“CPE”);
f. to enable SIM PL to advise the student on progression paths beyond the current programme;
g. to enable SIM PL to comply with the requirements as stipulated by the Private Education Act and the regulations made
thereunder and for SIM PL to disclose and transfer, where required, the student’s personal data to CPE, the Singapore
Ministry of Education and other relevant governmental bodies, agencies and / or other regulatory or competent authorities
in Singapore;
h. for SIM PL to disclose to the student and / or graduate or organisation (as instructed by the student / graduate), information as
may be necessary to verify his /her studies at SIM PL;
i. to enable SIM PL to conduct surveys and / research focusing on offering quality educational services and programmes that meet
the industry needs;
j. for SIM PL to register the student for SIM membership and any other purpose within the legitimate interest of SIM PL; and
k. to enable administration and management by SIM PL of secondary or ancillary programmes such as event or alumni activities
and network at SIM PL following graduation that may be of interest to the students and / or graduates.
The amount and type of personal data collected shall be limited to that which is necessary to fulfil the purposes identified, will be used
and processed by SIM PL reasonably and lawfully and will be retained for such period is necessary for legal or business purposes or to
fulfil the identified purposes.
By completing and submitting the programme application to SIM PL, you hereby:
12
a. understand the need for, and hereby consent to the collection, use and disclosure by SIM PL of your personal data to fulfil the
purposes identified;
b. confirm that the personal data provided are accurate, correct and not misleading in any way; and
c. authorise SIM PL to release and transfer the student’s personal data to the Partner Institution, if applicable, as is necessary to
fulfil the purposes identified.
I certify that all information given by me in this application form is true and correct. I understand that any misrepresentation or omission of
Applicant’s Declaration
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