SPAN Registration Form

Dear Alums,

Welcome to the Scholars Programme Alumni Network (SPAN). We would like to keep in touch with you as you move on to new endeavours. Please assist us by completing this form and send it back to us by email at [email protected], or dropping it off at the USP General Office. Thank you.

* Mandatory Fields (Enter "N.A." or "0" if you do not have values for mandatory fields) ++ (Your NRIC/Passport No. will be your login ID)

Section A: Contact Information Date of Registration : Status*:(Pls select one) USP Student Exchange Programme Student Title*: Mr. Ms. Dr. Others, pls specify: Name*: NRIC/Passport No*++: Matriculation No.*: Date Of Birth*: (Day) (Month) (Year) Gender: Religion: Ethnicity: Telephone (Home) No.*: Mobile Phone No.*: Fax No.: Email Address 1*: Email Address 2: Citizenship: Country you are in now:

Home Address:

Mailing Address*: (If different from home address)

Best means to contact me*: Email Snail Mail Mobile Phone Telephone (You can circle more than one)

Do you want to subscribe to our Yes No updates via email?

Last updated: 20 November 2014 Page 1 of 4 You may fill in section B & C later if you do not have the information now. You can update your information later by logon to your SPAN account.

Section B: Graduation Information And Continuing Education* Undergraduate Home Faculty: Degree Attained: Matriculation Year: Year of Graduation: Any plans to higher degree? (If yes, Type of Yes No Higher Degree?) Interested to apply for scholarships? Yes No Type of Higher Degree: Which Institution do you plan to join after graduation? Which Field of Study? Pursuing Continuing Education on Scholarship (Please state scholarship): Year of Award/s:

Section C: Employment Information* Current Employment Status: Employed Self-Employed Not Employed Company’s Name: Company’s Website: Department: Designation: Telephone (Work) No: Job Industry: Job Sector: Government Private Job Type Contract Full Time Part Time Temporary Annual Salary: Professional Affiliations: (Membership of societies, association, etc.) Professional Interests: (Areas of professional expertise and interests.)

Section D: Option to reveal your Information to Others May USP reveal your contact information to prospective employers? Yes No

May USP reveal your contact information to future students who are Yes No interested in your field?

Last updated: 20 November 2014 Page 2 of 4 Section E: Other Information

Personal Interests / Hobbies:

Contact Person Name and Tel No.: (Can you provide the name and contact number of the person whom we can contact if we lost contact with you.) Other Information: (Anything else you would like to share with the members.)

Section F: Feedback for Us What / Who prompted you to On own register? Friends Newsletter SPAN Web Email Accord USP (You can select more than one.)

Others, pls specify:

What kind of alumni Personal programmes / activities would Social Get- Global Programme Seminars Development you be interested to participate? Together Activities Courses (You can select more than one.)

Talks (Scholarships, Graduate Opportunities, HR, Others, pls specify: Employment-Related etc.)

What kind of activities / programmes would you be interested to organise, or help to organise? (Please specify):

Other feedback and/or suggestion/s:

Last updated: 20 November 2014 Page 3 of 4 Personal Data Protection Act (PDPA) Notice:

The National University of Singapore (“NUS”) recognises the importance of the personal data that you entrust to us; it is our responsibility to properly manage, protect and process your personal data. Common examples of personal data could include names, identification numbers, contact information, photographs and video images. The NUS, via its University Scholars Programme (“USP”), manages and administers your registration with Scholars Programme Alumni Network (“SPAN”), USP will necessarily need to collect, use, disclose and/or process certain personal data or personal information from you.

By registering for SPAN, you agree and consent to your personal data being collected, used, processed and disclosed in accordance with the Personal Data Protection Act 2012 and all subsidiary legislation related thereto for the following purposes:  Administering and/or managing your registration as an alumni and administering and/or managing your subsequent relationship with USP-NUS (including the mailing of correspondence to you which could involve the disclosure of certain personal data about you to bring about delivery of the same, as well as on the external cover of envelopes / mail packages);  Engaging you as an alum of USP-NUS, which includes but is not limited to notification on USP-NUS and alumni-related initiatives and activities, invitation to NUS and alumni-related events, updating of alumni information, invitation to participate in alumni surveys and sending of communication collaterals;  Responding to any enquiries by you;  Carrying out market related, evaluative or similar research and analysis for USP-NUS’ operational, strategy and policy planning purposes;  Garnering philanthropic support for USP-NUS and its community;  Inviting you to participate in publicity materials, feature stories, events, research and other engagement activities relating to academic support and your successful completion of USP-NUS;  Supporting USP-NUS functions including, but not restricted to, the teaching and personal and professional development of students of USP-NUS;  Sharing your information with students for purposes of recruitment, internship, industrial attachment and job placement;  Sending you materials relating to USP-NUS via postal mail and/or electronic mail  Sharing your personal data for the purposes of NUS’ participation in university-ranking exercises; and/or  Taking of photographs and/or videos (whether by NUS staff or third party photographers and/or videographers) during events or seminars organised by USP-NUS for publicity purposes (including in NUS’ publicity and communications materials).

Your personal data will/may be disclosed by NUS to third party service providers or agents (whether in Singapore or elsewhere in the world where such service providers are sited) for one or more of the above Purposes, as such third party service providers or agents, if engaged by NUS, would be processing your personal data for NUS, for one or more of the above Purposes. For the avoidance of doubt, in the event that Singapore personal data protection law permits an organization such as NUS to collect, use or discloses the Applicant’s personal data without the Applicant’s consent, such permission granted by the law shall continue to apply.

If you have any questions relating to NUS’s collection, use and disclosure of your personal data, you may contact the Data Protection Officer at [email protected] or call 6776 2835 or such other person as NUS may designate, from time to time, whether by informing you through any letter, circular, notice or email.

By submitting this registration, I acknowledge that I have carefully read and fully understand the above contents and hereby give my consent as set out above.

-----Thank you  -----

Last updated: 20 November 2014 Page 4 of 4