Alumnus/a Registration Form
Dear alumnus/a,
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
span@nus.edu.sg, 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)
Title*:
Name*:
NRIC/Passport No*++:
Matriculation No.*:
Date Of Birth*:
USP Student
Mr.
Ms.
(Day)
Exchange Programme Student
Dr.
(Month)
Others, pls specify:
(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*:
(You can circle more than one)
Do you want to subscribe to our
updates via email?
Last updated: 24 April 2009
Email
Snail Mail
Yes
Mobile Phone
Telephone
No
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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
Higher Degree?)
Yes
No
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:
Job Type
Government
Contract
Full Time
Private
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
interested in your field?
Yes
No
Last updated: 24 April 2009
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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
register?
(You can select more than one.)
Friends
Newsletter
SPAN Web
Email
On own
Accord
USP
Others, pls specify:
What kind of alumni
programmes / activities would
you be interested to participate?
(You can select more than one.)
Seminars
Social GetTogether
Talks (Scholarships,
Graduate Opportunities, HR,
Employment-Related etc.)
Personal
Development
Courses
Global Programme
Activities
Others, pls specify:
What kind of activities /
programmes would you be
interested to organise, or help to
organise? (Please specify):
Other feedback and/or
suggestion/s:
-----Thank you  -----
Last updated: 24 April 2009
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