CONFIDENTIAL

Scholarship Application Form

Please attach
a recent
passport-size
photograph
(nonreturnable)

Applied Major:

1. PERSONAL DATA (As shown in Personal ID/Passport)

Mr./Ms.
Name as in NRIC/Passport
Personal ID No.(NRIC)/ Passport No.

Citizenship / Country of Birth :

Date of Birth :

Age at last birthday :

Religion :

Marital Status:

Single / Married / Divorced / Widowed*

No. of Children :

2. ADDRESS
HOME
ADDRESS
In full and in block
letters.
SCHOOL
ADDRESS
In full and in block
letters.

Hobbies:

Mobile No.:

Email Address:

Phone No.:

Email Address:

3. EDUCATIONAL RECORDS
ACADEMIC/
PROFESSIONAL
QUALIFICATIONS
(In chronological order)

School/Junior
College/University
Attended
(& Country, if Overseas)

From
(Mth/Yr)

Certificate/Diploma/Degre
e
Mth/Yr
Attaine
(Mth/Yr)
Obtained (State Class &
d
Division of Honours, if
applicable)
To

PLEASE ATTACH
COPIES OF ALL
RELEVANT
CERTIFICATES &
DETAILED RESULTS.

MEMBERSHIP WITH
ANY PROFESSIONAL

BODIES,
INSTITUTES,
ASSOCIATIONS,
Etc.

Name of Institutes

Type of Membership
(Corporate/Associate/Student*)

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4. EMPLOYMENT HISTORY
PRESENT/ PREVIOUS

Appointment:

EMPLOYMENT

Employer:
Address:

Office Tel:

Period of
Appointment:
(dd/mm/yy)
Brief Description of
Duties:

From _____________ To
______________

Basic Salary:

Gross Salary:

Reason(s) for leaving:

5. FAMILY BACKGROUND
Fathers Name:
Mother's Name
Number of Sibling:

Occupation:

Company Name:

Occupation:

Company Name:

Older:

Younger:

6. DECLARATION
A) ANSWER THE FOLLOWING QUESTIONS BY DELETING "YES" OR "NO". IF "YES", GIVE DETAILS IN THE
SPACE PROVIDED
i) Are you currently serving a bond with any of the company or
institution?
YES/
NO
ii) Are you in receipt of any other scholarship
iii)Have you suffered or are suffering from any physical disability
or serious
illness? [If yes, give details]
iv) Have you committed any criminal offences and/or is there any
unsatisfied judgement or pending litigation against you?

YES/
NO
YES/
NO
YES/
NO

B) The information provided in my application is, to the best of my knowledge, complete and accurate, and I
understand that false
statements on this application will disqualify me from the
scholarship.

____________________________________
______________________________________
_
Signature of Applicant
Date
* To complete this application, please send your CV together with this Application Form, Certificates and

Transcripts.

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