Please read the USM Global Fellowship Application Guidelines at www.ips.

usm before competing this form

A. GENERAL INFORMATION
Please remember to attach a photo of yourself and copy of your passport (if any) / ID. Please provide your name exactly as they
are indicated in your passport/IC
Name:

I/D / Passport No (If any): Mailing Address:

Passport’s date and place issued:
Passport Expiry date:

Nationality:
Date of birth: Age:
E-mail: Contact Number:

B. ACADEMIC / PROFESSIONAL INFORMATION

Higher Education : Please enclose copies of all degrees awarded and university-issued transcripts
No secondary education certificates are needed nor any certificates of participation in conferences or training courses
Degree awarded Year Programme CGPA/Class/Gr Programme Mode University
(e.g) ade/Percentag (coursework/mixed
e mode/research)

C. ENGLISH LANGUAGE SKILLS (Please attach proof)

TOEF/IELTS BAND/SCORE DATE TAKEN

D. RESEARCH DETAILS FOR PHD STUDY

Indicate area of proposed research/study for PhD :

Indicate planned research title for PhD (please attach detailed research proposal) :

E. ACADEMIC/PROFESSIONAL EMPLOYMENT

Organisation (Employer) From To Position

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F. INVOLVEMENT/EXPERIENCE IN ACADEMIC & NON-ACADEMIC ACTIVITIES

Activity Position (e.g participant/organiser) Date

G. PUBLICATION ACTIVITIES
Indicate your publications details in journals. Please indicate details and proof where needed
Articles Published (reference format) ISI/Scopus Impact factor
Listings/Others

H. RESEARCH EXPERIENCE
Indicate your previous experience in research
Research undertaken Institution & Country Date

I. REFEREES : Indicate names address and contact details of a senior researcher/supervisor familiar with applicant’s work; their
reference letter must be letter-headed, signed and submitted to USM. There is no standard format. If sent by email, it should be a
scanned copy. The letter can be submitted either by the referee of by the applicant directly with this form.
Name:
Organisation:
Contact Number: Fax: E-mail:

Relationship to candidate:

Applicant’s acceptance of conditions governing the USM Global Fellowship

I, the undersigned, declare that the particulars given by me in this form are correct. I understand that the funding can be
withdrawn if any information given in this form is found to be inaccurate. I have read and understood the conditions of
the USM Global Fellowship as stated.

Applicant's Signature Date

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ENCLOSURES CHECKLIST
Important ; Please ensure that ALL relevant enclosures are included with the completed application form
Please only submit the material requested as any other material not listed is not required (e.g secondary
education certificates, certificates of participation in conference or training courses etc)
Passport size photograph
A copy of passport (if any) for non Malaysian applicant or ID. Only the first page with personal
details is required
Research Proposal
Proof of publication in journals (provide link if available on website)
Certified copies of University degree certificates and relevant university transcripts for all
academic degrees
Certified copy of IELTS/TOEFL 9if any)
Certificate of good health from a qualified medical doctor

OTHER INFORMATION
How did you find out about USM Global Fellowship?
Institute of Postgraduate Studies, Universiti Sains Malaysia’s website
Word of mouth/email from colleague
Newspaper
Recommendation of supervisor
Postgraduate Exhibitions / Student Recruitment Activities
Postgraduate Talks / Seminars
Others (please specify)

SUBMISSION GUIDELINES

For submission of application Dean,

by courier Institute of Postgraduate Studies
Universiti Sains Malaysia
11800 USM, Penang
MALAYSIA

Fax: +604-653 2940

For submission of application Please save the completed application form as an MS Word
by e-mail document with both your name and the Fellowship’s acronym in its
file name. Example: If your name is Ahmed Abu, name the file
“AHMED_USMGF.doc” as appropriate.

All proof and documents should be scanned and compressed

together with this application form in a zipped file to avoid your
documents to be missed out.

Please e-mail to usmglobal@gmail.com