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Scholarship Application


Scholarship Application Form

SECTION A : PERSONAL PARTICULARS AND COURSES TO APPLY
*PLEASE SELECT THE COURSES YOU WISH TO APPLY:
 Bachelor of Science in Business Administration (4+0) (in collaboration with TRINE UNIVERSITY, USA)
 Diploma in Business Administration
 Diploma in Accounting
 Diploma in Finance
 Diploma in Information Technology
 Diploma in Visual Arts
 Diploma in Hotel Management
 Diploma in Tourism Management
 Certificate in Business Studies
 
*APPLICANT’S FULL NAME :
*I/C NUMBER : *DATE OF BIRTH
(Day/Month/Year)
:
*AGE (YEAR) :
*CORRESPONDENCE ADDRESS :
*POSTCODE : *STATE :
HOUSE PHONE NUMBER : *HAND PHONE NUMBER :
*RELIGION : *RACE :
*NATIONALITY :
*EMAIL ADDRESS :
 
HIGHEST EXAMINATION PASSED
 SPM / O-Level     UEC     STPM / A-Level
 DIPLOMA IN :
 DEGREE IN :
*DATE OF COMPLETION
(Day/Month/Year)
:
*SCHOOL NAME/COLLEGE/UNIVERSITY :
 

Scholarship Application Form

SECTION B: PARENT’S/GUARDIAN’S PARTICULARS
*NAME OF PARENT/GUARDIAN :
*IC. NO (NEW) : IC. NO
NO. KAD PENGENALAN LAMA/POLIS
:
*RELATIONSHIP :
*H/P NO. : TEL NO. :
NO. OF CHILDREN : OCCUPATION :
MONTLY INCOME (RM) :
*CORRESPONDENCE ADDRESS :
*POSTCODE : *STATE :
COMPANY NAME & ADDRESS :
POSTCODE : STATE :
EMPLOYER’S TEL NO. :
 
 

Scholarship Application Form

SECTION C : ACCOMMODATION
 REQUIRED  NOT REQUIRED
MEDICAL CONDITION THAT REQUIRE THE ATTENTION OF THE COLLEGE (IF ANY) :
 
SECTION D : DOCUMENTS NEEDED FOR PTPTN ONLINE APPLICATION
*Please indicate items enclosed with this application :
  Certified copies of education certificates
  Certified copies of English tests (e.g TOEFL, IELTS)
  Photocopy of IC (both sides)
  Photocopy of IC (parents - both sides)
  Certified copies of examination results
  Eight passport-size photographs
 
SECTION E : TYPE OF SCHOLARSHIP APPLIED
  Academic Excellence Scholarship
  Co Curriculum, Sport or community Services Scholarship
  Hardship or Financial Need Scholarship
 
SECTION F : DECLARATION ON OTHER SCHOLARSHIPS
*Have you been awarded any other scholarship?
  Yes
  No
If yes, name the scholarship :
Amount awarded :
Duration of the scholarship :
 
 

Scholarship Application Form

SECTION G : DECLARATION & AGREEMENT
I, the undersigned, declare that the particulars given by me in this application form are correct. I have also read and understood the Terms and Conditions of the award as attached. I agree to abide by the Terms and Conditions of the scholarship/financial assistance/bursary. I understand that the award can be withdrawn if any information given in this form is found to be incorrect. I understand and agrree that the personal information given herein will be used for verification and other related administrative purpose only.
 
 
  • Email: study@iputra.edu.my
  • Phone: +6(06) 231 6826
  • Fax: +6(06) 231 7537
  • Address: Lot 1838, Jalan Tasik, Mukim Bukit Katil, 75450 Ayer Keroh, Melaka, Malaysia