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PHOTO

passport size (non-returnable)

SCHOLARSHIP AWARD 2014 APPLICATION FORM


OFFICE USE ONLY
Rejected Reference No : Shortlisted Awarded Date Of Interview :

INSTRUCTIONS
1. 2. Please read through the application form carefully and complete it in CAPITAL LETTERS Only certified true copies of testimonials and certificates should be attached. Kindly produce the originals when you are invited for an interview

A.

PERSONAL PARTICULARS

Name (as in NRIC)

NRIC No. Date of Birth Race Sex Male / Female Citizenship

Religion

Marital Status

E-mail Address

Contact Number (Residence) Permanent Address

(Mobile Phone) -

B.

DEGREE PARTICULARS

Discipline / Major

Intake Date -

Date of Completion -

Cumulative Grade Point Average (CGPA) / 4.00 sscale Grade Point Average (GPA) for st First Year 1 Semester / 4.00 scale Second Year 1 Semester / 4.00 scale Third Year 1 Semester / 4.00 scale Student ID Number
st st

2 Semester / 4.00 2
nd

nd

scale scale

Semester / 4.00

nd

Semester / 4.00 scale

C.

FAMILY PARTICULARS
Name of Parent(s) & Siblings Relationship Status / Occupation Monthly Gross Income (RM)

Total Income

D.

MONETARY AID FROM OTHER ORGANISATIONS


(Previously received & currently receiving) Form of Assistance (Scholarship/Loan)

Organisation

Amount

Period of Aid

University/College

E.

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

F.

EXTRACURRICULAR ACTIVITIES
(Please submit certified true copies of the relevant certificates)

YEAR

POSITION

SOCIETY / CLUB / ACTIVITIES

YEAR

LEVEL REPRESENTED

SPORTS

YEAR

POSITION / LEVEL

OTHER ACTIVITIES

G.

ACHIEVEMENTS / PRIZE AWARDED (if any) YEAR ACHIEVEMENT / PRIZE AWARDED

H.

OTHER PARTICULARS
YES / NO

(a) Do you have any relatives working in Aeon Co. (M) Bhd.?

* (b) If YES, please state : Name of relative : Company : Relationship : Department :

I hereby declare that all the information given by me herein before are true and correct in every aspect to the best of my knowledge and I understand that the Aeon Scholarship Award ("the Program") is under AEON CO. (M) BHD. ("the Company"). I agree to abide all the terms and conditions of this program. In any event, should any information stated above appear to be false, the Company shall reserves all the right against me including termination of this scholarship award against me without any notice.

Applicants Signature

Date

WHAT CORPORATE SOCIAL RESPONSIBILITY INITIATIVES WOULD YOU ENCOURAGE AEON TO ADOPT AND WHY
(Your essay should focus on your own opinions and thoughts, and be related to your personal experiences. Your essay should be 600 words and typed using New Times Roman font size 12 with double spacing and page setup must be adjusted to A4 sized paper.)

Document Checklist 2 Passport size photographs Photocopies of applicants and both parents IC (front & back 2 copies) Photocopies of Guarantors IC (front & back 2 copies) Certified true copies of academic certificates & transcripts (SPM, STPM, Matriculation, Ast Levels, 1 year degree transcript, etc.) Testimony letter from university on extracurricular activities Leaving school certificate (certified true copy) Both parents latest salary slip (certified true copy) Essay

** Closing Date : 5th May 2014