Scholarship Application Form

APPLICATION FORM FOR JEFFREY CHEAH FOUNDATION – SUNWAY BERHAD SCHOLARSHIP
Application Instructions
Please read the following instructions carefully before filling the Application Form.
1.
2.
3.
4.
The scholarship awards are open to Malaysian Citizens who wish to pursue their tertiary education.
Applicants should complete all parts of this form. State “NA” for sections not applicable to you.
State clearly in BLOCK letters.
Copies of all certificates and /or any other related documents (non-returnable) should be attached to this
application.
5. Where space is insufficient, please continue in separate sheet and attach to the Application Form.
6. Incomplete or late applications will not be accepted.
7. Attach your attachments in the following order:
Item
No
a.
b.
c.
d.
e.
f.
g.
h.
i.
List of Documents
Please
Tick
Recent passport-size photograph
Certified true copy of your National Registration Identification (NRIC)/MyKad
Certified true copy of your SPM certificate or equivalent
Certified true copy of your STPM certificate or equivalent
Certified true copy of your undergraduate studies examination results, if applicable
Certified true copy of your school testimonials and certificates of participation in
extracurricular activities.
Certified true copy of your parents’ recent pay-slips, latest Income Tax Statement or
any other proof of income
Official university unconditional/ conditional offer letter
Any other relevant document
8. Submit application form to JEFFREY CHEAH FOUNDATION, No 5, Jalan Universiti, Bandar Sunway,
47500 Selangor Darul Ehsan. For further enquiries, please call (603) 5638 3575.
Closing Date: 31st May 2015 | Only shortlisted candidates will be contacted for the interview.
Jeffrey Cheah Foundation – Sunway Berhad Scholarship Application Form
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APPLICATION FORM FOR JEFFREY CHEAH FOUNDATION – SUNWAY BERHAD SCHOLARSHIP
Section A: Personal Information (use block letters)
Name
Date of Birth
I/C No
Gender (M / F)
Passport
Size
Photo
Home Address
Tel. No.
H/P No
Present
Address
Tel. No.
Email address
Section B: Academic Qualifications
Please enclose certified copies of academic results, testimonial, school leaving certificate etc
Academic Qualification (Circle
where applicable)
Actual Results
Forecast Results
Month & Year of
Competion/
Expected Completion
SPM/ O-Levels
STPM/ UEC/ A-Levels/
Matriculation
Others, please specify:
______________________
Section C: Programme Applied For
Please enclose official university conditional/ unconditional offer letter
Universities/
Institutions
Programme
Intake
Duration
Section D: Other Qualifications / Achievements
Please attach certified copies of testimonials and certificates
Activities in School/ College
Year
Position
Prizes/Awards won such as academic/subject/prizes, trophies, medals for sports/ other
competition
Jeffrey Cheah Foundation – Sunway Berhad Scholarship Application Form
Year
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APPLICATION FORM FOR JEFFREY CHEAH FOUNDATION – SUNWAY BERHAD SCHOLARSHIP
Section E: Family Background
Please attach a certified copy of Parents’/Guardian’s income tax Statement and Last Drawn Salary Slip
Father / Guardian
Name:
Mother / Guardian
Name:
Age:
Occupation: *
Income per month (RM): Occupation:
Age:
Income per month (RM):
*Name & Address of Employers:
*Name & Address of Employers:
Additional Income per month (RM):
Additional Income per month (RM):
Total Income per month (RM):
Total Income per month (RM):
*Please indicate if your parents/guardians are self-employed. For retirees, the last drawn salary slip.
Siblings’ Details:
Siblings Who Are Working
Name
Name
Name
Age
Age
Age
Gender
Occupation
(M/F)
Name of Company
Monthly
Income
(RM)
Monthly
Contribution
to Family
(RM)
Siblings Who Currently Pursuing Their Education
Gender Name of School / College
Source of Financial Support
(M/F)
Other Dependents
Gender Relationship
(M/F)
Jeffrey Cheah Foundation – Sunway Berhad Scholarship Application Form
Source of Financial Support
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APPLICATION FORM FOR JEFFREY CHEAH FOUNDATION – SUNWAY BERHAD SCHOLARSHIP
Section F: Family Expenditure
i
Type of Expenditure
House Installments / Rental
Monthly (RM)
ii
Electricity Bill
iii
Water Bill
iv
Telephone / Handphone
v
Loan Repayment:
- Hire Purchase Loan
- Personal Loan
- Other Loan
vi
vii
Transportation Cost:
- School Bus
- Petrol
- Etc.
Education Expenses for ________ person(s)
viii
Medical Expenses
ix
Foods/ Living Expenses
x
Insurance Premium
xi
Other. Please specify: _____________________
_____________________
Yearly (RM)
Total Expenditure:
Section G: Relationships
Please indicate below any relatives and siblings who are employed the Jeffrey Cheah Foundation’s
Sunway Education Group of institutions and the Sunway Group
Name
Age
Gender
(M/F)
Company/Institution
Jeffrey Cheah Foundation – Sunway Berhad Scholarship Application Form
Designation
Relationship
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APPLICATION FORM FOR JEFFREY CHEAH FOUNDATION – SUNWAY BERHAD SCHOLARSHIP
Section H: Personal Statement
Please tell us in your own words more about yourself that is not covered in the above sections/questions
which you believe will assist the Scholarship Selection Committee in its decision. Your Personal Statement
should be not more than 400 words.
Section I: Recommendation Letter
Please attach a recommendation letter from your teacher, advisor or official in support of your application.
You may provide more than one Recommendation Letter. However, it has to be from a person who is
familiar with your achievements and progress.
Section J: Declaration
I also hereby warrant that I have obtained all necessary consent from the third party where I have provided
their personal information as part of my application such as information relating to my parents.
I consent to any educational institution at which I have previously been a student and/or my current or any
past employer, providing the JEFFREY CHEAH FOUNDATION with information which they hold about me
for the purpose of the JEFFREY CHEAH FOUNDATION verifying my grades and/or qualification and
experience.
I authorise the JEFFREY CHEAH FOUNDATION to release fee and academic progress information to cosponsor of the scholarship (if any).
I declare that the information contained in this application form and in the attached documents are true and
accurate to the best of my knowledge at this time. I acknowledge that the JEFFREY CHEAH FOUNDATION
reserves the right to seek from other relevant bodies verification as to the standing of my claimed
qualifications. I further acknowledge that the JEFFREY CHEAH FOUNDATION reserves the right to vary or
reverse any decision regarding admission made on the basis of incorrect or incomplete information and that
should the information be found false at any stage, the scholarship will be terminated immediately and I will
be liable to re-pay the JEFFREY CHEAH FOUNDATION the total sum of any payments already received.
Applicant’s signature
Date of application
Thank you for your application.
Jeffrey Cheah Foundation – Sunway Berhad Scholarship Application Form
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