PERSA TUA N KEBA JIKA N IN SPIRE ( IN SPIRE SOCIET Y )

(PPM -012-10-05022015)
N o. 10, Jalan Temenggung, T aman Desaw ira,
T elok Panglima Garang, 42500, Kuala Langat, Selangor.
EM A IL: inspireusm@gmail.com

IFA2019
INSPIRE FINANCIAL ASSISTANCE FOR UNIVERSITY ENTRANCE 2019
INSPIRE is a charity organization, formed by a group of concerned USM Indian Graduates to help
the needy in our community through education.

INSPIRE is inviting eligible Indian students, who have been offered a place in local Government
(IPTA) universities to do their first degree, to apply for this financial assistance. A sum of
between RM 1,000 to RM 3,000 per student will be given to help with initial Entrance Fees,
expenses and to ease the financial burden while waiting for the PTPTN loan to be released.

The applicants should fulfill the following criteria:

1. Malaysian citizens of Indian origin.
2. Has been offered a placement to do their First Degree in Local Public Universities.
3. Total household income of less than RM 3,000 per month.
4. The latest salary slip for every individual in the Household should be emailed with
this form
5. Facing financial difficulties for the initial University Entrance Fees and expenses.
6. Applicant must apply for PTPTN / financial aid in order to pursue their studies.
(Shortlisted candidates will be required to show proof of PTPTN / financial aid
application when required by Inspire)

Students who fulfill the above criteria are invited to apply by filling up the attached form. We may
do house visits and / or phone calls to confirm the above criteria are complied with.

Completed forms together with the required documents should be sent to the following
email: inspireusm@gmail.com

For Enquiries: Kuhan 0122071708 / Keamalatha 01112372673 / Vasanthi 0162020119

Only successful applicants will be notified. Financial assistance will be given via a cheque, at a
ceremony, which will be held on Saturday the 17th of August 2019 in Klang Valley.

The selection of the successful applicants is at the sole discretion of INSPIRE SOCIETY.

Attendance is compulsory.

• This application invitation consists of 3 pages (Inclusive of this page).

• Inspire Financial Assistance (IFA) is not to reward high achievers but to help students in real
need of financial assistance with their initial University Entrance Payment.

Closing date for IFA2019 application: 6th August 2019.

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APPLICATION FORM- INSPIRE FINANCIAL ASSISTANCE FOR UNIVERSITY ENTRANCE 2019

Full Name
NRIC no Mobile Number Home Number
Email Address
Permanent
Address
Type of Please Indicate: Own * Social Media Instagram Snapchat FB
residence Rented Username / Handle

Academic Qualification
Level Name of School /College /Polytechnic CGPA Year Completed
Foundation / STPM
/ Matriculation
Course offered in 2019 University Offered in 2019

Family Particulars – Please state every individual in the household with an income.
Full Name Mobile Relationship Occupation Monthly BSH
Number Income (BR1M)
Father Yes/no
Mother Yes/no
Brother / Sister Yes/no
Brother / Sister Yes/no
Yes/no
Total Number of Family Members Total Household Income RM

FAMILY EXPENSES / MONTHLY

Living Expenses Medical Rental Education ASTRO Insurance Others
RM RM RM RM RM RM RM
Particulars of other family members who are currently studying in College / Polytechnic / University.
University Course Year Funded By RM

Referee (One of your teachers, who is not related to you / no family relationship)
Name Contact Number Email address

I hereby confirm that the information provided by me in this application form is true and accurate. I
understand that providing false or misleading information will result in the rejection of my application.

__________________ __________________
(Applicant's Signature) (NRIC No)
# Attach photocopy of your Offer letter from the University and latest Pay slip.
# Only shortlisted applicants will be notified.
# * We may communicate through your preferred social media regarding your application.

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A brief write-up on why you need financial assistance.
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IFA2019

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