TUN RAHAH SCHOLARSHIP AWARD

SECTION A : PERSONAL DETAILS

Name (as per NRIC) : Identity Card Number : Date of Birth : Home Address : Age : Citizenship :

Recent passport size photograph of applicant

Gender :

Correspondence Address (if different from the above) :

E-mail address : Contact No (residence) : Mobile No : Student ID No. : If currently employed (permanent or temporary), please state occupation : Present Status No of months / years in employment : Last drawn salary per month :

SECTION B : COURSE DETAILS

Course attending : Name of University : Location : Date of Commencement : Duration :

Amount per annum which can be obtain from family / other sources (in RM)

*please enclose the acceptance letter from the relevant university

SECTION C : FAMILY DETAILS Parents

Name of Father / Guardian : Identity Card No : Occupation : Salary / Income / Pension (RM per month) :
*delete accordingly

Age : Contact No : Name of Employer :

Name of Mother / Guardian : Identity Card No : Occupation : Salary / Income / Pension (RM per month) :
*delete accordingly

Age : Contact No : Name of Employer :

Siblings (excluded applicant) Name 1) 2) 3) 4) 5) 6) 7) 8) Relationship Age Occupation Gross Income

SECTION D : LANGUAGE
Languages 1) 2) 3) 4) 5)
*please indicate the proficiency level ; (satisfactory / good / excellent)

Speak

Write

Read

SECTION E : EDUCATION BACKGROUND

Schools/Universities/Colleges Attended 1) 2) 3) 4) 5)
*please enclose a copy of SPM, SPM (V), STPM, Matriculation, Foundation, Diploma, Bachelor

From

To

Result

SECTION F : EXTRA CURRICULAR ACTIVITIES

Society / Club / Other Activities 1) 2) 3) 4) 5) 6) 7) 8) 9) 10)
*please enclose a copy of certificate, testimonials

From

To

Position Held

Type of Sports / Games 1) 2) 3) 4) 5) 6)

*please enclose a copy of certificate, testimonials

Year

Level

Presenting

SECTION G : REFEREES
1) Name : Contact No : Relationship : Occupation : Years Known :

2) Name : Contact No : Relationship : Occupation : Years Known :

*Members of the family or relatives are excluded to be referees

SECTION H : PERSONAL MOTIVATION / OBJECTIVES

*Write a short essay on your career aspirations

SECTION I : OTHER INFORMATION & DECLARATION

Please state other relevant information to support your application expenses.

I, the undersigned declare that the information given by me in this form is true to the best of my knowledge and that I have not willfully suppressed any material facts relevant to this application. I have read and agreed to abide by the terms and conditions of the scholarship/financial assistance. I understand that the scholarship herein can be withdrawn at any time if any information given is found to be incorrect. I have read and understood the conditions of the award as stated in the application form and the Terms and Conditions

____________________________

____________________________

Applicants Signature

Date

SECTION J : DOCUMENT CHECKLIST

Have you enclosed CERTIFIED TRUE COPIES Yes 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. University acceptance letter Parents / Guardians proof of income for the past 1 year (please provide yearly income statement or 3 months latest pay slips.) Brothers and sisters proof of income for the past 1 year, if they are working. Letters or documents to prove that brothers and sisters are pursuing higher education in universities / colleges / institutions Identity card and birth certificate of applicant Birth certificates of all brothers and sisters Parents / Guardians identity cards SPM / SPVM / O Level Results STPM / A Level / Matriculation / Foundation results University / College / Polytechnic results School leaving certificates No

*please tick () for Yes.