SCHOLARSHIP AND STUDY GRANT APPLICATION FORM

Please complete this form and submit it together with the Foundation/Undergraduate Programme Application Form.
Programme Applied For:
Degree Programme Intake: Feb Apr Sept Foundation Programme Intake: Apr Aug

PERSONAL DETAILS (Please write in BLOCK CAPITAL)

Name (as per your NRIC/passport): _______________________ Chinese name: _____________________
Gender: Male Female Date of birth (day/month/year) : _____________ NRIC/passport No.: _______
Nationality: ____________ Country of permanent residence: ______________
Correspondence address:__________________________________________________________________________________
__________________________________________________________________________________
Telephone (H): __________________ Mobile: _________________ Email address:________________________________

You are applying for (Tick the applicable box):

MERIT SCHOLARSHIP
ACADEMIC QUALIFICATION:
Name of institution and location : __________________
Last examination/Highest qualification obtained: _____________________
Year of examination: ____________________________________________

Note: Please attach a CERTIFIED TRUE COPY of your academic qualification to this application form. Any
results that are pending MUST be submitted as soon as they are released.

TEACHERS CHILDREN STUDY GRANT

DETAILS OF PARENTS:
Fathers name: ____________________________ NRIC No.: ___________________________
Occupation: ______________________________ Monthly Gross Income: _______________
Mothers name: ____________________________ NRIC No.: ___________________________
Occupation: ______________________________ Monthly Gross Income: _______________
DOCUMENT CHECKLIST:
Certified true copy of parents NRIC
Certified true copy of teachers ID card/Parents latest salary slip
Certified true copy of applicants birth certificate

SIBLING STUDY GRANT

Siblings name: ____________________________ NRIC No.: ____________
Occupation: ______________________________
DOCUMENT CHECKLIST:
Certified true copy of applicants birth certificate
Certified true copy of siblings NRIC
DECLARATION

Declaration by Applicant
I have read and fully understood all the terms and conditions governing this application. I hereby declare
that all information provided in this application and its attachments or supporting documents are true,
correct and complete in all respect and no information has been willfully or intentionally misrepresented,
withheld or concealed. I acknowledge and agree that Xiamen University Malaysia (XMUM) reserves the
right to vary or reserve any decision regarding scholarships and study grants made on the basis of
incorrect, incomplete or fraudulent information. I have read the Personal Data Protection Notice of XMUM
accessible via www.xmu.edu.my and I hereby agree and consent to the use, processing and transfer of
my personal data by XMUM in accordance with the terms of the said Notice.

________________________ ______________________
Applicants own signature Date

Declaration by Parent/Legal Guardian (if applicant is below 18 years old)

I have read and fully understood all the terms and conditions governing this application. I consent to my
child/ward signing this document and any other necessary forms relating to his/her application for a
scholarship or study grant at XMUM. I agree and undertake to make payment of all fees and charges, less
the amount granted under a scholarship or study grant, due to XMUM by the prescribed date. I
acknowledge and agree that XMUM may, without prejudice to any other rights or remedies, bar my
child/ward from attending classes including deregistration due to default in payment of fees and charges.
I have read the Personal Data Protection Notice of XMUM accessible via www.xmu.edu.my and I hereby
agree and consent to the use, processing and transfer of my personal data by XMUM in accordance with
the terms of the said Notice.

________________________ ______________________
Signature of parent/guardian Date

XIAMEN UNIVERISTY MALAYSIA DULN009(B)

Jalan Sunsuria, Bandar Sunsuria, 43900 Sepang, Selangor Darul Ehsan, Malaysia
Tel: 03-7610 2084 / 2079 / 2078 / 2091
www.xmu.edu.my