A-Level Scholarships Application Form
Content
Sunway University College A-Level Scholarships Application Form
Please attach passport size photo here
A. Personal Particulars (Please use BLOCK LETTERS)
Full Name (as per IC) IC No. E-mail Address Home Address Postcode Home / Permanent Tel No. Gender Male Female Town Mobile Phone No. Date of Birth Nationality Race State
B. School / Institution
Name of School Address Contact No.
C. Details of Parents / Guardian (Please use BLOCK LETTERS)
Name of Father (as per IC / Passport) Occupation Company / Organisation Name Company / Organisation Address Office Tel No. Name of Mother (as per IC / Passport) Occupation Company / Organisation Name Company / Organisation Address Office Tel No. Mobile Phone No. Mobile Phone No. IC / Passport No. IC / Passport No.
Are your parents financing your studies?
Yes
No
If not, please specify below Name of Guardian (as per IC / Passport) Occupation Company / Organisation Name Company / Organisation Address Office Tel No. Mobile Phone No. IC / Passport No.
Checklist for documents to be enclosed
Completed application form One (1) passport-size photograph One (1) copy of of Identity Card Certified true copies of examination results • Form 4 mid-year and final examination results (as per report card / book / school report) • Form 5 mid-year examination results
D. Academic Qualifications
No. Subject Mid-Year Exam Results Form 4 (2009) Marks Bahasa Malaysia English Mathematics Grades Final Exam Results Form 4 (2009) Marks Grades Mid-Year Exam Results Form 5 (2010) Marks Grades
Note: Please attach a Certified True Copy of your actual results and report card / book
E. Extra-Curricular Activities
No. 1. 2. 3. 4. 5.
(Please complete this section in detail. You may attach a separate sheet, if required) Position Held Year
SPORTS / SOCIETIES / CLUBS / UNIFORMED BODIES
No. 1. 2. 3. 4. 5.
OTHERS (eg. Prizes / awards won such as academic / subject / prizes, trophies,
medals for sports / other competition)
Year
Note: Please attach a Certified True Copy of certificates of ECA achievements with this application form
F. Submission Instructions
Submission deadline is by 5.00pm on 13th August 2010. The application is to be mailed, couriered or handed in to: Sunway University College A-Level Scholarships 2011 c/o Marketing Department No. 5, Jalan Universiti, Bandar Sunway 46150 Petaling Jaya, Selangor Darul Ehsan
G. Declaration by Applicant
I, the undersigned, declare that the particulars provided by me in this application form are correct, and that I have read, understood and agree to abide by the Terms and Conditions of the Sunway University College Cambridge A-Level Scholarships. I understand that the scholarship will be withdrawn if any information provided in this form is found to be inaccurate, fraudulent or in contradiction to the Terms and Conditions of this scholarship.
Signature of Applicant
Name of Applicant (as per IC)
Date
Please attach passport size photo here
A. Personal Particulars (Please use BLOCK LETTERS)
Full Name (as per IC) IC No. E-mail Address Home Address Postcode Home / Permanent Tel No. Gender Male Female Town Mobile Phone No. Date of Birth Nationality Race State
B. School / Institution
Name of School Address Contact No.
C. Details of Parents / Guardian (Please use BLOCK LETTERS)
Name of Father (as per IC / Passport) Occupation Company / Organisation Name Company / Organisation Address Office Tel No. Name of Mother (as per IC / Passport) Occupation Company / Organisation Name Company / Organisation Address Office Tel No. Mobile Phone No. Mobile Phone No. IC / Passport No. IC / Passport No.
Are your parents financing your studies?
Yes
No
If not, please specify below Name of Guardian (as per IC / Passport) Occupation Company / Organisation Name Company / Organisation Address Office Tel No. Mobile Phone No. IC / Passport No.
Checklist for documents to be enclosed
Completed application form One (1) passport-size photograph One (1) copy of of Identity Card Certified true copies of examination results • Form 4 mid-year and final examination results (as per report card / book / school report) • Form 5 mid-year examination results
D. Academic Qualifications
No. Subject Mid-Year Exam Results Form 4 (2009) Marks Bahasa Malaysia English Mathematics Grades Final Exam Results Form 4 (2009) Marks Grades Mid-Year Exam Results Form 5 (2010) Marks Grades
Note: Please attach a Certified True Copy of your actual results and report card / book
E. Extra-Curricular Activities
No. 1. 2. 3. 4. 5.
(Please complete this section in detail. You may attach a separate sheet, if required) Position Held Year
SPORTS / SOCIETIES / CLUBS / UNIFORMED BODIES
No. 1. 2. 3. 4. 5.
OTHERS (eg. Prizes / awards won such as academic / subject / prizes, trophies,
medals for sports / other competition)
Year
Note: Please attach a Certified True Copy of certificates of ECA achievements with this application form
F. Submission Instructions
Submission deadline is by 5.00pm on 13th August 2010. The application is to be mailed, couriered or handed in to: Sunway University College A-Level Scholarships 2011 c/o Marketing Department No. 5, Jalan Universiti, Bandar Sunway 46150 Petaling Jaya, Selangor Darul Ehsan
G. Declaration by Applicant
I, the undersigned, declare that the particulars provided by me in this application form are correct, and that I have read, understood and agree to abide by the Terms and Conditions of the Sunway University College Cambridge A-Level Scholarships. I understand that the scholarship will be withdrawn if any information provided in this form is found to be inaccurate, fraudulent or in contradiction to the Terms and Conditions of this scholarship.
Signature of Applicant
Name of Applicant (as per IC)
Date
