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COURSE APPLICATION FORM

* mandatory field
 
Course Applying For *:
Commencing on *:
Have you studied at Counselors' Academy / Lee Community College before? *
 Yes  No
 
1. PERSONAL DETAILS
Salutation *:
Full Name as in NRIC/Passport *:
Surname *:
Given Name *:
IC / Passport No *:
Gender *:  Male  Female
Address 1*:
Address 2 :
Address 3 :
Postal Code *:
Country *:
Tel *:
  -     -     (Home)
  -     -     (Office) 
  -     -     (Mobile) 
Country Code Area Code Phone Number
Email *:
Occupation *:  Working  Not Working
Marital Status :
Date of Birth *:  (dd/mm/yyyy)
Nationality *:
Religion :
 
2. PRESENT EMPLOYMENT DETAILS
**mandatory for applicants who are working
Company Name **:
Company Address **:
Postal Code **:
Tel **:
Fax **:
Type of Industry **:
Current Title / Designation **:
Job Description **:
Contact Details of HR Department
Contact Person **:
Tel **:
Email **:
 
3. PAYMENT ARRANGEMENTS *
 I am company sponsored
 I am applying for SDF
 I am applying for bank loan
 I am making self payment via cash / cheque
 
4. EDUCATIONAL QUALIFICATION DETAILS
Highest Academic Qualification *:
From (Date) *:    To     (dd/mm/yyyy)
Name of Institution *:
Other Qualification :
From (Date) :    To     (dd/mm/yyyy)
Name of Institution :
Other Qualification :
From (Date) :    To     (dd/mm/yyyy)
Name of Institution :
 
5. OTHER COURSES YOU ARE PURSUING
  Course Institution Date of Final Examination
1.   (dd/mm/yyyy)
2.   (dd/mm/yyyy)
3.   (dd/mm/yyyy)
4.   (dd/mm/yyyy)
 
6. APPLICANT'S COUNSELING EXPERIENCE
 
7. REASONS FOR APPLYING FOR THIS COURSE *
 
8. Are you undergoing / have undergone any medical or psychiatric treatment? *
Yes No
 
9. Are you currently taking any prescription drugs? *
Yes No
 
10. REFUND DUE TO STUDENT'S WITHDRAWAL
All registration fees paid to LCC are non-refundable. Only the paid course fees are refundable on the stipulated conditions below.
Percentage of Refund for Paid Course Fees Receipt of Student's Written Notice of Withdrawal
100% More than 45 days before the Commencement Date
75% Between 45 days to 30 days before the Commencement Date
50% Between 29 days to 21 days before Commencement Date
25% Between 20 days to 14 days before the Commencement Date
0% Less than 14 days before the Commencement Date
10.1 In the event that a company-sponsored student withdraws, the company is liable to pay any outstanding tuition fees.
10.2 In the event if the payment is made using a credit/charge card, the refund will be made to that card less bank charges.
10.3 If a study loan is procured, the refund will be made to the financial institution from which the loan is obtained from, less any necessary bank charges.
 
11. CHANGES OR CANCELLATION OF COURSES
Lee Community College reserves the right to vary or cancel any of the courses described or alter the course syllabus as well as the venue for lectures should the circumstances so require.
 
12. APPLICANT'S CHECKLIST AND DECLARATION
I certify that all the information given by me in this application are true and correct and I understand that misrepresentation or omission is sufficient grounds for rejecting my application.
 
Registration will be confirmed only after receipt of payment.
Please make cheque payable to "Lee Community College Pte Ltd".

  
LEE COMMUNITY COLLEGE
20 Maxwell Road #13-00 Maxwell House S'pore 069113
Tel: +65 6221 3326 Fax: +65 6227 5415
Email: info@lee.edu.sg
 
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