Merdeka Scholarships

o
f
n
o
t

Closing Date : 2
m
201
o
r
e

Note:

1. Secti
ons
mark
ed
***
must
be
comp
leted

t
h
a
n

2. Pleas
e use
UPPE
R
CAS
E
LETT
ERS
unles
s
stated
other
wise

3. Pleas
e
attach
the
follo
wing
docu
ments
:

1
.

1
,
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0
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:

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A
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t
ford;
e
The
personal
qualities that make you
n
a worthy recipient of a
d
scholarship;|
e
d
2.
A
list
of
a
academic
r
qualifications and
e
other awards and
a
honours received
o
3.
A copy of the
f
document showing
s
the status of your
t
application to the
u
University
of
d
Oxford
y
4.
Two
;
confidential letters
of recommendation
H
from referees who
o
can
assess
the
w
applicants
t
academic
h
performance
i
s
w
i A. DEGREE APPLIED
l
l FOR ***
b (Note: All applicants should apply to
e the University of Oxford. This
n Section refers to the candidates
e separate application to the University
f of Oxford)
i
t
M Degree
Masters
DPhil
a
l
a Course Name and Code
y
s Department
i
a Status of Application for Admission to the University of Oxford:
;
a) Date of Application
R
e
b) Status of Application
Pending
a
s
Offered a conditional offer
o
n
Offered an unconditional offer
s
f
o
r
w
a B. PERSONAL
n PARTICULARS ***
t
i (Note: All applicants should apply to
n the University of Oxford. This
Section refers to the candidates
g separate application to the University
t of Oxford)
o
s
t
Full Name
u
d
IC No (New)
y
i
n
Place of Birth
O
x

Date of Birth
Permanent address

Country
(If outside Malaysia only)

Mailing address

Postcode
Town
State

Country
(If outside Malaysia only)

Telephone

Mobile

Email

(Use uppe

Home
Marital Status

Number of Childr

C. QUALIFICATIONS ***
i - Professional qualification
attained
Professional body
State

Country

Discipline
Year (From)
Parts Completed

Year (Completed)
All

Part

Highest part completed

ii - Masters Degree
Institution / University
State

Country

Discipline
Year (From)

Year (Completed)

CGPA / Grade

ii - First Degree
Institution / University
State

Country

Discipline
Year (From)
CGPA / Grade

Year (Completed)
Point / Class

ii - Diploma
Institution / University
State

Country

Discipline
Year (From)

Year (Completed)

CGPA / Grade

D. VOLUNTARY ACTIVITIES (Attach a full description if

necessary) i - Society / Club
No

Society / Club

Position / Role Assumed

Year

Sports / Games

Represented

Year

1
2
3

ii - Sports / Games
No
1
2
3

iii - Awards / Commendations (Name main awards)

No

Awards / Commendations received

Level

Year

1
2
3

E. EMPLOYMENT (If Relevant)

Please provide details of current / last employment, if any :

Are you currently employed ?

Yes

No

Current / Last Employer Address

Number of years with current/last employer

Position in company
Last drawn monthly salary

RM

F. REFEREES ***
Please give details of the two referees who have written letters of recommendation on your behalf.

Referee 1
Name
Address

Position
Email address
(Use upper or lower case as per actual address)

Referee 2
Name
Address

Position
Email address
(Use upper or lower case as per actual address)

F. DECLARATION ***
1

I consent to the collection, processing, sharing and use of relevant personal data by the Centre for the purposes of processing my
application for study, for administration and (where applicable) for funding purposes, subject to the provisions of the Data
Protection Act 1998.

I understand that such personal data may be used and shared with third parties, some of which may be located overseas (including
outside the European Economic Area), for the purposes of verifying my identity, qualifications, work experience, references and any
submitted work. Where I apply for funding through the University, my personal data may be shared with third parties relevant to
that funding application.

I understand that the Centre will normally only discuss my application with me, unless I have nominated a third-party agent on
my application form.

I understand that if any information or statement provided on or to support this application form is not true, accurate, current and
complete, or any supporting material is not entirely my own original work, except where clearly stated otherwise, the Centre may
process and use this fact as relevant personal data. Such data may be used and shared with third parties, including Higher Education
institutions, some of which may be located overseas (including outside the European Economic Area), to the extent necessary for
the purpose of preventing fraudulent or dishonest applications for study, funding and/or visas.

I understand that if I become a registered student, any personal data collected by the Centre as a result of my application will form
part of my student record.

Name
Date