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 I understand that the award can be withdrawn if any information given in this form is found to be incorrect.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.