serial no: application for umw scholarship programme 2017 name course pursued current year of study & semester university recent photograph important ...
Download 6 May 2015 ... Feb 2016. Issuance of annual report and audited Financial statements ...... earned UMW a 'syarikat Contoh' (exemplary company) award from.
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SERIAL NO:
APPLICATION FOR UMW SCHOLARSHIP PROGRAMME 2017
Recent Photograph
NAME COURSE PURSUED CURRENT YEAR OF STUDY & SEMESTER UNIVERSITY
IMPORTANT NOTES 1. Please attach certified copy of: a) Previous semester's examination result (Foundation / Matric / Diploma / STPM / A-Levels) b) Offer Letter from University c) Student's NRIC d) Student's bank account statement - for Company to verify bank account number e) Parents' latest 3 month's salary slip or bank statement f) Any other documents that may support your application (eg. extracurriculum cert) 2. Application form must be fully completed. Incomplete form will not be processed 3. The complete form must be certified by Student Affairs Department (Bahagian Hal Ehwal Pelajar) and must reach us on or before 11 October 2017.
Page 1 of 3
PERSONAL DETAILS Name
Gender
NRIC No.
Place of Birth
Date of Birth
Race
Age Permanent Address
Marital Status
MALE
Contact No
FEMALE
(Mobile) (Home)
Postcode
City/State
Postcode
City/State
(E-mail)
Mailing Address (If different form above)
Immediate Contact Person
Contact No
EDUCATIONAL BACKGROUND CURRENT EDUCATIONAL BACKGROUND
Faculty
Location
Course Pursued
Duration
Year/Semester
(e.g. Year 1/Semester 1)
Current/Past Scholarship or Financial Assistance (If any) Amount (RM)
per annum
Bonding (If any)
If you do not receive Scholarship or Financial Assistance, how do you plan to proceed with your studies?
DECLARATION ON DISCIPLINARY ACTION
Have you ever faced any disciplinary action?
YES
NO
If yes, please specify when and the offence
EDUCATIONAL HISTORY SECONDARY SCHOOL/UNIVERSITY
QUALIFICATION
YEAR
RESULT/CGPA
CO-CURRICULUM SECONDARY SCHOOL/UNIVERSITY
CLUB/SOCIETY
Page 2 of 3
POSITION
YEAR
FAMILY INCOME/BACKGROUND DETAILS OF PARENTS/GUARDIAN NAME
INCOME PER MONTH (RM)
OCCUPATION & EMPLOYER
AGE
FATHER : MOTHER : TOTAL INCOME
Note: Please attach copy of latest salary slip/bank statement as proof DETAILS OF SIBLINGS NAME
MARITIAL STATUS
AGE
RELATIONSHIP
INCOME PER MONTH (RM)
OCCUPATION
DECLARATION BY APPLICANT I hereby declare that the information given in this form is correct and true to the best of my knowledge. I fully understand and accept that if at any time after the offer, it is found that a false declaration has been made, UMW has the absolute right to terminate my scholarship and I undertake to refund the scholarship in full.
Signature
Name
__________________ Date
_______________
VERIFICATION BY UNIVERSITY (Student Affairs Dept/Bahagian Hal Ehwal Pelajar) We hereby certify that the above student is currently:
pursuing his/her study at our university
receiving PTPTN loan
receiving financial assistanc/ loan from other organization Name of organization
____________________________________
Name
Designation
____________________________________
Official Stamp
Signature
__________________
Date _______________
FOR UMW USE ONLY
1. INTERVIEWER
REMARKS (Name:
)
(Name:
)
2. INTERVIEWER
REMARKS
DECISION
RECOMMENDED Name _______________________________________________
