Application Form Scholarship 2011

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SCHOLARSHIP AWARD 2011 APPLICATION FORM
A. APPLICANT PARTICULARS
i. ii. iii. iv.
v.

Latest Colour Passport Size Photo

Name IC No. (New) Sex Citizenship Age as at Dec 2010 House Tel No. Permanent address

______________________________________________ ______________________________________________ Male / Female _______________ _______________ _______________ Race Religion E-mail _________________ _________________ _________________

vi. vii.

Mobile Phone _________________

______________________________________________ ______________________________________________

viii.

Correspondence address (if different from above)

______________________________________________ ______________________________________________

B.

DEGREE PARTICULARS
i. ii. iii. iv. University Degree Registration date ______________________________________________ ______________________________________________ _______________ Year of Completion ___________

Course Fee per year (excluding lodging, food, etc.) RM

_________________

C.

STAFF PARTICULARS (For Maybank Group staff only)
i. ii. iii. iv. Name IC No. (New) House Tel No. Present SSC/Dept ______________________________________________ _______________ _______________ IC No. (Old) ________________

Mobile Phone ________________

________________________________ PF No: _______

D.

FAMILY PARTICULARS
1

Name of Parent(s) & Siblings

Relationship

Status / Occupation

Monthly Gross Income RM

Total Income

E.

MONETARY AID FROM OTHER ORGANISATIONS (PREVIOUSLY RECEIVED & CURRENTLY RECEIVING)
Organisation Amount Form of Assistance (Scholarship/Loan) Period of Aid University/College

PARTICULARS OF ACADEMIC QUALIFICATIONS
(Please submit certified true copies of the relevant certificates) Year / Semester SPM STPM Matriculation / A-Levels Diploma Degree (latest semester) A Results (CGPA / Grade) B C D E G School / Institution

2

G.

ACTIVITIES / SPORTS
(Please submit certified true copies of the relevant certificates) YEAR POSITION SOCIETY / CLUB / ACTIVITIES

YEAR

LEVEL REPRESENTED

SPORTS

YEAR

POSITION / LEVEL

OTHER ACTIVITIES

I confirm that the above information is correct and true.

Applicant’s Signature

Date

Document Checklist 2 Passport size photographs Photocopies of applicant’s and both parents’ IC (front & back – 2 copies) Guarantor’s IC Certified true copies of academic certificates & transcripts (SPM, STPM, Matriculation, ALevels, 1st year degree transcript, etc.) Testimony letter from university on extracurricular activities Leaving school certificate/Sijil berhenti sekolah Both parents’ latest payslip (certified true copy) 3

** Closing date : 6th February 2011

4

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