Persatuan Pendidik Malaysia/⼤⻢教育公会 16/06/2023, 2:02 PM

Persatuan Pendidik Malaysia/⼤⻢教育公会

Malaysia Educator Association

Email *

dorothytbk@gmail.com

A. PROGRAMMED PREFERRED AND FEE /课程

LEVEL

DIPLOMA

BACHELOR OR DEGREE

MASTER DEGREE

COURSE /科系
（Please list out three choices of courses /请选择三个科系）

Sciences biology chemistry, science food & engineering chemical

https://docs.google.com/forms/u/2/d/1TK1tNYMcnAsa40cZ4DsNZ5…Jo_6ZfsjL-RoMfPyBk0zkeTdaQM1PHr9L8n3T_ckNJcaMaIGqWWFRrtE4w Page 1 of 10
Persatuan Pendidik Malaysia/⼤⻢教育公会 16/06/2023, 2:02 PM

DURATION OF COURSE/课程时间 *

1 YEARS

2 YEARS

3 YEARS

4 YEARS

5 YEARS AND ABOVE

B. PERSONAL PARTICULARS/个⼈资料

FULL NAME/姓名 *

Charis Loo Si Qi

DATE OF BIRTH/⽣⽇⽇期 *

DD MM YYYY

24 / 11 / 2005

NRIC/身份证号码: *

241105010922

https://docs.google.com/forms/u/2/d/1TK1tNYMcnAsa40cZ4DsNZ5…Jo_6ZfsjL-RoMfPyBk0zkeTdaQM1PHr9L8n3T_ckNJcaMaIGqWWFRrtE4w Page 2 of 10
Persatuan Pendidik Malaysia/⼤⻢教育公会 16/06/2023, 2:02 PM

MARITAL STATUS/婚姻状况 *

SINGLE

MARRIED

ADDRESS/地址 *

8, Jalan Puteri Indah 2 /1, Taman Puteri Indah, 83000 Batu Pahat, Johor

TEL. NO. HOME/家⾥电话

TEL.NO.MOBILE/⼿机号码 *

0177062552

RELIGION/宗教信仰

Christian

https://docs.google.com/forms/u/2/d/1TK1tNYMcnAsa40cZ4DsNZ5…Jo_6ZfsjL-RoMfPyBk0zkeTdaQM1PHr9L8n3T_ckNJcaMaIGqWWFRrtE4w Page 3 of 10
Persatuan Pendidik Malaysia/⼤⻢教育公会 16/06/2023, 2:02 PM

PERSONALITY/性格

INTROVERT/内向

EXTROVERT/外向

HOBBIES/爱好

Play piano, dancing

OKU/您是属于OKU吗？ *

YES/是

NO/不是

C. EDUCATION BACKGROUND/教育背景

PRIMARY SCHOOL/⼩学 *

SRJKC HUA MIN

SECONDARY SCHOOL/中学 *

SMK CONVENT BATU PAHAT

https://docs.google.com/forms/u/2/d/1TK1tNYMcnAsa40cZ4DsNZ5…Jo_6ZfsjL-RoMfPyBk0zkeTdaQM1PHr9L8n3T_ckNJcaMaIGqWWFRrtE4w Page 4 of 10
Persatuan Pendidik Malaysia/⼤⻢教育公会 16/06/2023, 2:02 PM

Name of University/⼤学
如果已被⼤学⼊取，请填写⼤学名字和开学⽇期。若⽬前正读着中六的学⽣，请填写中六选择理科
或⽂科.

申请UTAR

D. RESULT/成绩

UPSR

A B C D E

Bahasa
Melayu(Pemahaman)

Bahasa
Melayu(Karangan)

English

Mathematic

SCIENCE

华语理解

华语作⽂

https://docs.google.com/forms/u/2/d/1TK1tNYMcnAsa40cZ4DsNZ5…Jo_6ZfsjL-RoMfPyBk0zkeTdaQM1PHr9L8n3T_ckNJcaMaIGqWWFRrtE4w Page 5 of 10
Persatuan Pendidik Malaysia/⼤⻢教育公会 16/06/2023, 2:02 PM

PT3

A B C D E

Bahasa Melayu

English

Science

Mathematic

Bahasa Cina

Geoghraphy

Sejarah

Other subject

SPM/O level

A+ A A- B+ B C+ C D E

Bahasa Melayu/Malay
Language

Bahasa
Inggeris/English
Language

Sejarah/History

https://docs.google.com/forms/u/2/d/1TK1tNYMcnAsa40cZ4DsNZ5…Jo_6ZfsjL-RoMfPyBk0zkeTdaQM1PHr9L8n3T_ckNJcaMaIGqWWFRrtE4w Page 6 of 10
Persatuan Pendidik Malaysia/⼤⻢教育公会 16/06/2023, 2:02 PM

Matematik/Mathematic

Pendidkan Moral/Moral
Education

Sains/Science

Fizik /Physic

Kimia/Chemistry

Biologi/Biology

Bahasa Cina/Chinese
Language

Prinsip
Perakaunan/Principle
of Accounting

Subjek Lain/Other
Subject

Row 13

https://docs.google.com/forms/u/2/d/1TK1tNYMcnAsa40cZ4DsNZ5…Jo_6ZfsjL-RoMfPyBk0zkeTdaQM1PHr9L8n3T_ckNJcaMaIGqWWFRrtE4w Page 7 of 10
Persatuan Pendidik Malaysia/⼤⻢教育公会 16/06/2023, 2:02 PM

STPM/A Level/Matriculation/Diploma/统考

A A- B+ B B- C+ C C- D+ D

GENERAL
STUDIES

HISTORY

PHYSIC

BIOLOGY

CHEMISTRY

MATHEMATIC
M

MATHEMATIC
T

ECONOMY

GEOGRAPHY

ACCOUTING

OTHER

E. FAMILY MEMBERS' DETAIL/家庭资料

https://docs.google.com/forms/u/2/d/1TK1tNYMcnAsa40cZ4DsNZ5…Jo_6ZfsjL-RoMfPyBk0zkeTdaQM1PHr9L8n3T_ckNJcaMaIGqWWFRrtE4w Page 8 of 10
Persatuan Pendidik Malaysia/⼤⻢教育公会 16/06/2023, 2:02 PM

Parents and Siblings Details/⽗⺟和兄弟姐妹资料 *

Name, Age and Job or School (姓名，年龄，⼯作或学校名字）

Loo Nyak Yong(father ) , Tan Bee Kheng(mother) , Stella Loo Si Yi (younger sister)

F. CO-CURRICULUM VATAE/课外活动资料

CO-CURRICULUM VATAE/课外活动资料 *

Persatuan bahasa English, pasukan Kadet, Permainan badminton

G. PERSONAL ACHIEVEMENT/个⼈成就

PERSONAL ACHIEVEMENT/个⼈成就 *

Kuiz kimia kebangsaan Malaysia (K3M) 2022

Ride & Run 2022
Pertandingan bola jaring P15 MSSD Batu Pahat Tahun 2022
MESAC 2022 Malaysia Explore STEM And Coding
Pertandingan Menulis Karangan Panjang Program Dasar Emas (DWEN) & Program Kerjaya Dihatiku
2020

H.WORKING EXPERIENCE/⼯作经验

WORKING EXPERINCE/⼯作经验 *
(Name of company, position and years of working)

Tuisyen centre

WHY DO YOU APPLY SCHOLARSHIP/为什么申请资助⾦？

https://docs.google.com/forms/u/2/d/1TK1tNYMcnAsa40cZ4DsNZ5…Jo_6ZfsjL-RoMfPyBk0zkeTdaQM1PHr9L8n3T_ckNJcaMaIGqWWFRrtE4w Page 9 of 10
Persatuan Pendidik Malaysia/⼤⻢教育公会 16/06/2023, 2:02 PM

REASON/申请原因： *
AT LEAST 100 WORDS/⾄少100个字

B40群体

This content is neither created nor endorsed by Google.

 Forms

https://docs.google.com/forms/u/2/d/1TK1tNYMcnAsa40cZ4DsNZ…Jo_6ZfsjL-RoMfPyBk0zkeTdaQM1PHr9L8n3T_ckNJcaMaIGqWWFRrtE4w Page 10 of 10