Professional Documents
Culture Documents
RECENT PHO OTO
PUTR
RAJAYA PERDAN
P NA BERH
HAD
(Passport sizze)
SCHOLARSH HIP APPLICATIION FORM
(For universsity/college neew intake:
mester 1 appl icants only)
Year 1 / Sem
INSTRUCTTIONS:
Please reaad all the insttruction careffully and fill in n the form coomplete (unleess indicated o otherwise)
Incomplette form will b be disqualified d immediately.
1. Please e type or writte clearly.
2. Use o only BLOCK LEETTERS.
3. Those e who have no ot gained adm mission to Unniversity/Colleege/Polytechnic should staate their first choice
of cou urse and nam me of University/College/Po olytechnic.
4. All the e information n filled in this form is to ind dicate your n ext level of eeducation. Eg.. You have
comp pleted your Diiploma, so thaat informatio on below shouuld be filled b based on yourr next level off
educaation, ie Degree. Do not fill your past ed ducation info rmation in th his form excep pt in Part 3.
5. If pare ent(s) are retired but workking part‐time e, please statte their part‐ttime job in brrackets.
6. If pare ent(s) are decceased, pleasse submit cop py of death ceertificate(s).
7. If space is insufficie ent, please co ontinue on a separate she et with respeective section n of the form cclearly
stated d in the attachment(s). Eg:: HEADING: PART 2: Perso nal Details
8. Copy of the following items must be attache ed and arrangged in this maanner: 1) IC, 2 2) Academic R Results
(starting with the h highest to low west), 3) pare
ent(s)’ death ccertificate(s) (if applicable),
4) Parent(s)’LATESST EA form/saalary slip/inco ome tax noticce of assessm ment/pension card
APPLICAT TION DATA SH HEET
Name of A Applicant: Hand pphone: Level: Degreee / Diplo
✔ oma
TEH QIAN HUA (please select onee to indicate your next level of
017-2879736 education which yyou will be pursuing)
Email: Locatioon of currentt residence: (nname the state only e.g.: Perak)
thomas3241@gmail.com
SELANGOR
Course: - Date oof admission tto university//college:
-
Name of IInstitution: Locatioon of Instituttion:
- KUALA LUMPUR
Date of Graduation: esttimated Previoous academic result: choose whichever applicaable
- • STPM: Num mber of As ( )
• Diploma: C CGPA ( )
• Matriculatiion/Foundatio on: CGPA ( )
4.00
• Others: _________________________________
Have you applied to PP PB Scholarship before? Your FFather’s Occu upation: Parents’ combin ned
YES ( ) NO (
✔ ) TEACHER Inccome:
4000.00
OFFICE USSE ONLY
Rejectted
Reference e No: Shortliisted Date of Intterview:
AWAR RDED
Part 1: COURSE
Course Applied For
Name of Course Degree/Diploma Name & location of Institution
1. First Choice:
UNIVERSITY OF MALAYA
CHEMICAL ENGINEERING DEGREE
Why do you choose this as your first choice?
I HAVE THICK INTEREST IN PHYSICS AND CHEMISTRY
2. Second Choice:
3. Third Choice:
Duration of Course
Duration of Course: Date of commencement of Date of completion of course:
course:
Expenses (estimates) Incurred While Pursuing The Course
Tuition Fee: Other fees: Monthly Handphone fee:
RM RM RM
Meals per day: Monthly accommodation Other form of monetary
charges: expenditure:
RM RM
Other Financial Aids (scholarship/bursary/study loan/grant)
I am currently benefiting from these financial support stated below ( )
I am current applying for these financial support stated below ( )
Name of sponsor Amount per year Bonding period (if Duration of sponsorship
any) (From X year to Y year)
Part 2: Personal Details
Full Name (as in IC):
TEH QIAN HUA
Permanent Address:
RUMAH GURU SMJK YOKE KUAN, 45400, SEKINCHAN, SELANGOR DARUL EHSAN
684,
Postal Address:
684, RUMAH GURU SMJK YOKE KUAN, 45400, SEKINCHAN, SELANGOR DARUL EHSAN
Home Phone: Mobile Phone: Email:
03-32410802
017-2879736 thomas3241@gmail.com
NRIC Number: Age: Race:
920204-14-6397
19 CHINESE
Marital Status: Gender:
SINGLE
MALE
Parents/Guardian Details
Father/Guardian Mother
Name
TEH KIN KIN
TAN CHU NGO
NRIC No.
550526-
Nationality
Age
Occupation*
Monthly Income#
Company Name
Address and contact
number
Handphone No.
House Address
House Contact No.
Date of
Retirement/Deceased
*If retired and working part time, please state the part time job
#
If monthly income varies, please provide the average monthly income
Siblings Details
Full Name Age Gender Relationship School/Institute/ Scholarship/ Marital Monthly
College/University/ Monthly Status financial
Occupation Salary support
given to
family
(RM)
Household Income per month: parents & non‐married siblings’ income
Physically Challenged Family Members (disability, diseases, impairs, etc)
Name Relationship Illness/Impairs Duration
Other remarks on family income/support received:
Other family financial commitment (eg. Housing loan, car loan, etc):
Family House:
Type of house (single storey Ownership (owned or Monthly loan Number of people living
terrace, 3‐room apartment) rented) payment/rental in the house (including
payment relatives if any)
Vehicles:
Number of vehicle Make & Model of Owners of the Age of the vehicles Monthly car loan
in the family the vehicle vehicles payment or fully
paid off
19
Part 3: Academic History (previous education records)
College/Polytechnic Results
Academic Year Semester GPA CGPA for the Entire
Course
1 1
2
3
2 1
2
3
3 1
2
3
Pre‐University
Examination Year Results (eg: numbers of As achieved) CGPA
STPM A =
B =
C =
D =
OR
Matriculation Semester 1 GPA =
Semester 2 GPA =
Semester 3 GPA =
Semester 1 GPA =
Semester 2 GPA =
Semester 3 GPA =
OR
Others (please state) Semester 1 GPA =
Semester 2 GPA =
Semester 3 GPA =
Semester 1 GPA =
Semester 2 GPA =
Semester 3 GPA =
Secondary Examinations:
Examination Year Results
SPM A =
B =
C =
D =
Part 4: Extra Curricular Activities
School (Form 4 and above), Polytechnic
Year Position Held Club/Society/Sports Name of institution
PART 5: REFEREE (NOT YOUR RELATIVES. PREFERABLY YOUR LECTURERS/TEACHERS)
Full Name: Contact No:
Address: Employer’s name & address:
Nationality: Occupation:
No of years known: Relationship: (e.g. Lecturer, Former Employer, etc)
PART 8: DECLARATION
I declare that the information given in this application form is true. I understand that false information
given is ground for immediate cancellation of this scholarship
___________________________________________ ___________________
Signature of Applicant Date