GeronTech Ambassador (GTA) Programme (Batch #5) Registration

GeronTech Ambassador (GTA) Programme (Batch #5) Registration

Volunteer To Empower Seniors With Gerontech
Completion of this form does not confirm or guarantee your placement for the GeronTech Ambassador programme. Shortlisted candidates will be notified to attend an interview by SG Assist.

This programme is a sponsored programme and is free of charge to attend.

Please note that you need to be 50 years old & above to qualify for the programme.
Please select the program date*
Your Name*

Given NameSurname/Family Name
MrMrsMdmMsDrOther
MaleFemale
Age*
You must be 50 years and above to qualify
ChineseIndianMalayEurasian
Singapore CitizenPermanent Resident
Which district do you live in? (e.g. Yishun, Sembawang, Admiralty)
Residential Postal Code*
Please enter a valid postal codeFormat: 000000.
Birth Date*

DayMonthYear
Date
Are you currently volunteering in any Active Ageing Centre, National Library Board, or with any Community Partners?*
Email address*
example@example.com
Contact number (Mobile) eg. 91234567
Please enter a valid phone number.Format: 00000000.
PrimarySecondaryCertificateDiplomaDegreePost-GraduateDoctorate
EnglishChineseHindiMalayTamilOther
NoneCantoneseHokkienTeochewKhek (Hakka)Other
My main motivation for attending this GeronTech Ambassador programme is...*
Select date for interview*
Workshop Name
Submission Date

MonthDayYear
Date
SG Assist (Facebook, Instagram, Telegram）SG AssistSG Caregivers（Telegram）SG Assist Social Media (Facebook, Instagram, Telegram...)SG Assist NewsletterSG Caregivers (Telegram Group)Via Events/ RoadshowsWord of mouth (e.g. friend, family member, colleague)CCA staffOther
YesNo
I understand that the information I am providing on this GeronTech Ambassador (GTA) Programme – Registration Form is for registration purposes. The information will be used by SG Assist, Singapore University of Social Sciences (SUSS), and the service provider(s) for the purpose of the programme administration. The information I provided will not be used by SG Assist and SUSS for any other purpose other than the above without my written consent and as per prevailing Singapore rules and regulations regarding data collection, data protection, and data use. Please visit the SG Assist website for further details on our privacy policy, including how you may access and correct your personal data or withdraw consent to the collection, use or disclosure of your personal data.*

Yes
Should be Empty: