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Scholarship application form.

Complete all required sections and upload the supporting documents in PDF, PNG, JPG, or JPEG format. Each file must be 2MB or smaller.

Section 1: Personal Details

First Name * Surname * Date of Birth * Identity Card Number * Place of Birth *

Have you applied for any other scholarships? Yes No

If YES, where at?

Have you applied for a PTPTN Loan? Yes No

Current Home Address * Correspondence address * Your phone number * Email Address *

Section 2: About your course and university or college

Please give details of your University, College, Vocational School and course applied for. Option 1 is required.

Option 1

Name of University/College/Vocational School * Name of Course * Course Start Date (Month and Year) Course End Date (Month and Year) Course Length (Years) * Fees payable per year: MYR *

Option 2

Name of University/College/Vocational School Name of Course Course Start Date (Month and Year) Course End Date (Month and Year) Course Length (Years) Fees payable per year: MYR

Option 3

Name of University/College/Vocational School Name of Course Course Start Date (Month and Year) Course End Date (Month and Year) Course Length (Years) Fees payable per year: MYR

Section 3: Your bank account details

Bank Name * Bank Branch (Location) * Account number *

Type of Account * Savings Account Current Account

Section 4: Secondary Contact Information

Contact 1

First Name(s) * Surname * Relationship to You * Phone Number * Address *

Contact 2

First Name(s) * Surname * Relationship to You * Phone Number * Address *

Section 6: Upload Relevant Documents

File extension PDF, PNG, JPG, or JPEG is allowed. Max file size: 2MB each.

a) Copy of your Identity Card * b) STPM/SPM Result chit * c) Parent(s) last 3 months salary slip or latest Income Tax Form * d) School Testimonial * e) Passport size photos *

Section 7: Main Reasons Why I Need This Scholarship So Badly Main Reasons *

Section 8: Declaration

The letter of award will state that the award is granted upon certain conditions including but not limited to the statements included in the application remaining true and accurate at the time of award.

By ticking the box below, you are confirming that you have read the terms and conditions of the scholarship.

I confirm that to the best of my knowledge and belief, the information I have provided is true and complete. If it is not, I understand my scholarship application may be withdrawn.

I agree to provide any information required to process my application and agree to tell immediately if my circumstances change in any way that might affect my entitlement to financial support. I understand that if I do not do this, I may not receive any further payments, and may have to repay the financial support I have already received.

I hereby accept upon the above terms and conditions *

Full Name (in BLOCK CAPITALS) * Identity Card Number *

Scholarship application form.

Option 1

Option 2

Option 3

Contact 1

Contact 2

Parent

Q1 Household Income

Assets and commitments

Q2 Family Members

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Brothers and sisters who are working

Working sibling 1

Working sibling 2

Working sibling 3

Working sibling 4

Working sibling 5

Disabled family member