MALAYSIAN RUBBER EXPORT PROMOTION COUNCIL

MREPC SCHOLARSHIP AWARD

GUIDE: 1. Use UPPERCASE to complete this form. 2. Attach certified true copies of academic transcripts and/or certificates and all relevant documents. 3. Ensure all information given are correct. 4. Completed forms to be sent to Malaysian Rubber Export Promotion Council (Scholarship Award Secretariat) Block 2A, Level 13A-1, Plaza Sentral, Jalan Stesen Sentral 5, 50470 Kuala Lumpur. 5. Only shortlisted applicants will be notified.
UNIVERSITY PLACEMENT (SECURED):
1.

YES

NO
Choice And Discipline:

If Yes, Name of University:

2. Choice And Discipline:

Paste a recent passport-sized photograph here

3.

Choice And Discipline:

A. PERSONAL PARTICULARS Full Name (as per NRIC) NRIC Place of Birth Gender Marital Status Home Address City/Town Postal & State Tel No. (Home) E-mail Address
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Date of Birth Age Male Female Ethnicity Religion

Tel No. (Mobile)

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B. SECONDARY ACADEMIC QUALIFICATIONS STPM A-Levels School/Institute SUBJECT GRADE SUBJECT GRADE Year Year Others (please state below): Year

Cumulative Grade Point Average (CGPA): Matriculation Diploma Institute/University SUBJECT GRADE SUBJECT GRADE Year Year

Cumulative Grade Point Average (CGPA): Sem 1 SPM School SUBJECT GRADE SUBJECT GRADE Year Sem 2 Sem 3 Sem 4

MREPC Scholarship Award Application Form 2012

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MREPC SCHOLARSHIP AWARD

C. FIELD OF STUDY (if applicable) Name of University Actual Name of Course Applied/ Pursuing Date of Commencement Duration of Course Address City/Town Postal & State D. TERTIARY ACADEMIC INFORMATION (if applicable) Institute/University Date of Commencement SEMESTER CGPA SEMESTER CGPA Date of Completion Total Tuition Fees (RM)

E. EXTRACURRICULAR ACTIVITIES No. 1. 2. 3. 4. No. 1. 2. 3. 4.

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Societies/Clubs

Position/Role

Year

Awards/Contributions

Sports/Games

Position/Role

Year

Awards/Contributions

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No. 1. 2. 3. 4. Others Position/Role Year Awards/Contributions

F. DETAILS OF PARENTS/GUARDIANS Father/Guardian Name (as per NRIC) Citizenship Religion Date of Birth Tel No. (Home) Occupation Employers Name & Address New NRIC/ Old NRIC Ethnicity Place of Birth Tel No. (Mobile) Monthly Income

Mother/Guardian Name (as per NRIC) Citizenship Religion Date of Birth Tel No. (Home) Occupation Employers Name & Address New NRIC/ Old NRIC Ethnicity Place of Birth Tel No. (Mobile) Monthly Income

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MREPC SCHOLARSHIP AWARD

G. ESSAY QUESTION (not more than 200 words) Describe your most meaningful achievements and how they relate to your career goals in rubber industry.

H. REFEREES Please name TWO (2) referees whom we could contact for a personal reference about your academic and/or achievements. Referee 1 Name (as per NRIC) Address Position Tel No. Referee 2 Name (as per NRIC) Address Position Tel No.
MREPC Scholarship Award Application Form 2012

E-mail Address

E-mail Address
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MREPC SCHOLARSHIP AWARD

I. DECLARATION

I hereby declare that all information provided in this form are accurate and true. I understand that MREPC reserves its rights to disqualify my application should any information furnished be discovered as inaccurate and untrue.

Applicants Signature

Date

NOTE: Please attach the following documents with your submission.

1. Copy of applicants NRIC 2. Copy of relevant academic results/transcripts 3. Copy of extracurricular certificates 4. Copy of offer letter from Institute of Higher Learning (Please ensure that all documents above are verified)

FOR OFFICE USE

Date Received:

Verified & Checked by:

Ref No.:

Remarks:

MREPC Scholarship Award Application Form 2012

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