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NATIONAL UNIVERSITY OF SINGAPORE
DIVISION OF GRADUATE MEDICAL STUDIES
Application Form
Qualifying Examination (QE) for Speech-Language Therapists
1
Name of Employing Organisation: _________________________________________________
Address of Employing Organisation: _______________________________________________
Contact Person:
Tel Number:
Email Address:
2
Name of Candidate:
Mailing Address:
Email Address:
Tel Number:
NRIC/FIN/Passport number:
Country of Issue:
Date of Birth:
Number of Attempt(s):
Registration Status:
Gender:
st
1
/ 2
nd
(delete accordingly)
M / F
Date of previous QE:
New registration applicant / Restricted registrant
(delete accordingly)
Professional Qualification/s Obtained
3
Name of Institution/s
Year Qualified
Employment Status of Candidate (only for New registration applicants)
Position of Employment
Organisation Name
Job Offered
Current Employment
Signature of employer:
Date:
4
Official stamp:
I, ____________________________(Name of candidate) hereby fully consent to the
National University of Singapore (“NUS”) collecting, using and/or disclosing my personal
data in any form and to disclose the same to third parties (including the Allied Health
Professions Council (“AHPC”) or any other third party located in or outside of Singapore)
for the purpose of:





processing, handling, and managing my application;
subsequent registration to the QE venue;
releasing my results to the AHPC;
processing, administering my payment of the QE and
all other actions necessary in relation to the above.
in compliance with the Singapore Personal Data Protection Act 2012.
Signature of candidate:
5
Date:
Please send the completed application form together with payment and;
a) A certified true copy of the confirmation letter from AHPC to sit for the QE
(only for new registration applicants); OR
b) A certified true copy of the Restricted registration certificate from AHPC
c) A certified true copy of the IELTS/TOEFL/OET score/s
Before the stipulated closing date to:
Ms Doris Yeo
SLT QE Board
c/o Division of Graduate Medical Studies, Yong Loo Lin School of Medicine
National University of Singapore, Block MD 3, Level 2, 16 Medical Drive, Singapore 117597
Tel: (65) 6516 6740
email: [email protected]
PAYMENT INSTRUCTIONS
The QE fee is SGD 3199.30, inclusive of GST.
Mode of payment:
Cheque
Bank draft
Credit/Debit card
(Tick as appropriate)
For Cheque/Bank draft payment:
No.
Description
1.
QE fee
Cheque/Bank draft No.
Amount with GST (SGD)
$3199.30
Note: Please make the above cheque/bank draft payable to the “National University of Singapore” with your
name on the back of the cheque/bank draft.
For Credit/Debit card payment at the cashier of DGMS: Only Mastercard or Visa is accepted.
REFUND POLICY

No refunds of the examination fee will be issued for withdrawals. All refund requests will be considered
on a case-by-case basis, and must be in writing to the SLT QE Board via email/letter by the date of the
respective examination.

SLT QE will run with a minimum of 2 candidates. In the event of only one candidate registering for the
examination, a refund will be given.
For Official Use Only
Candidate No:
Cheque/Draft No. & Amount: _________________________ Receipt No: __________________________
Cheque/Draft Received on: __________________________ Receipt Issued on: _____________________
Credit Card Payment/Amount: ________________________ Receipt No: ___________________________