Scholarship 2015 application form
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This document is a scholarship application form for the Yayasan Bursa Malaysia Scholarship Programme. It requests personal details of the applicant such as name, date of birth, citizenship, address, academic qualifications, extracurricular activities, details of any previous scholarships, intended course of study, and financial details of parents/guardians. The applicant must declare that all information provided is accurate and the form includes verification sections to be completed by an employer, headmaster, or government official to validate the applicant's information. Required supporting documents are also listed.
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Scholarship 2015 application form
- 1. A. Personal Particulars Name: Date of birth: Place of birth: Age: Citizenship: I/C No: Permanent address: E-mail Address: House telephone no: Hand phone no: Are any of your parents an employee of Bursa Malaysia? Yes. Name: ___________________________________________ No How do you come to know about the Yayasan Bursa Malaysia Scholarship? Newspaper Bursa Malaysia website Word-of-mouth/ Friends/Relatives Others (please specify): __________________________________ Yayasan Bursa Malaysia Scholarship Programme Scholarship Application Form 2015/2016 Page 1 of 5 Paste a recent passport-sized photograph here. YAYASAN BURSA MALAYSIA SCHOLARSHIP PROGRAMME Scholarship Application Form 2015/2016
- 2. B. Academic Details – Please tick () STPM A-LEVELS MATRICULATION FOUNDATION SCHOOL/INSTITUTION: YEAR TAKEN: SUBJECT GRADE SUBJECT GRADE Malaysian University English Test (MUET): Band _______ Cumulative Grade Point Average (CGPA): Sem. 1 Sem. 2 Sem. 3 Sem. 4 SPM Year: SUBJECT GRADE SUBJECT GRADE GCE ‘O’ Level English (1119): Grade _______ Yayasan Bursa Malaysia Scholarship Programme Scholarship Application Form 2015/2016 Page 2 of 5
- 3. C. Extra-Curricular Activities - Please tick () Represented Sports School University /college District State Country Role Uniform troop / Association / Club Member Treasurer Secretary Vice President President Ad-hoc Committee D. Scholarship History- Please tick () Have you received any scholarship before? Yes No If yes, please provide details: Sponsor Organization Duration Value (RM/Year) Are you currently bonded to any scholarship agreement? Yes No E. Course/Programme Details Applied for this Scholarship Programme of study (eg: Bachelor In Accountancy) Name of institution (eg: Universiti Malaya) Commencement date/ session (eg: 1/8/12 / Semester I, 2012/2013) Duration of study (eg: 4 years) Expected graduation date: (eg: August 2016) Yayasan Bursa Malaysia Scholarship Programme Scholarship Application Form 2015/2016 Page 3 of 5
- 4. F. Details of Father / Guardian Name: Citizenship: New I/C no: Old I/C no: Date of birth: Place of birth: House tel no: Hand phone no: Occupation: Monthly income: Name & address of employer: Signature: G. Details of Mother / Guardian Name: Citizenship: New I/C no: Old I/C no: Date of birth: Place of birth: House tel no: Hand phone no: Occupation: Monthly income: Name & address of employer: Signature: H. Details of Siblings No. Name Age Date of birth Occupation/ Student Employer/School 1 2 3 4 5 6 7 8 Yayasan Bursa Malaysia Scholarship Programme Scholarship Application Form 2015/2016 Page 4 of 5
- 5. Declaration I hereby declare that all information furnished above are accurate and true to the best of my belief and Yayasan Bursa Malaysia reserves its rights to terminate/withdraw this application should any information furnished be discovered as inaccurate and untrue. Name: Applicant’s Signature: Date: * To be Completed By Employer of Parent/ Guardian/ Headmaster/ Principal/ Penghulu/ Government Officer within the home vicinity I hereby verify that all information furnished above are accurate and true to my knowledge. Name: Designation: Signature: Date: Official stamp: Note (*): If any of the parents is an employee of Bursa Malaysia Bhd, this section must be completed by Head of Department/Section. FOR OFFICE USE Date received: Signature: Note: Please check the availability and verification of the following documents and attached them with your submission. Please tick ( ) 1. Copy of I/Cs of applicant and parents/guardian 2. Copy of examination results 3. Copy of co-curricular activities certificates/ testimonials 4. Copy of Offer Letter from institution of higher learning (if available) 5. Latest copy of parents/guardian salary slip Yayasan Bursa Malaysia Scholarship Programme Scholarship Application Form 2015/2016 Page 5 of 5
- 6. Declaration I hereby declare that all information furnished above are accurate and true to the best of my belief and Yayasan Bursa Malaysia reserves its rights to terminate/withdraw this application should any information furnished be discovered as inaccurate and untrue. Name: Applicant’s Signature: Date: * To be Completed By Employer of Parent/ Guardian/ Headmaster/ Principal/ Penghulu/ Government Officer within the home vicinity I hereby verify that all information furnished above are accurate and true to my knowledge. Name: Designation: Signature: Date: Official stamp: Note (*): If any of the parents is an employee of Bursa Malaysia Bhd, this section must be completed by Head of Department/Section. FOR OFFICE USE Date received: Signature: Note: Please check the availability and verification of the following documents and attached them with your submission. Please tick ( ) 1. Copy of I/Cs of applicant and parents/guardian 2. Copy of examination results 3. Copy of co-curricular activities certificates/ testimonials 4. Copy of Offer Letter from institution of higher learning (if available) 5. Latest copy of parents/guardian salary slip Yayasan Bursa Malaysia Scholarship Programme Scholarship Application Form 2015/2016 Page 5 of 5