姓名(如身分證所示): (英) 申請科系編號

Full Name (as shown in IC) (Course No. )

摘要 Summary (申請者必須清楚填妥 This summary has to be filled in clearly by applicant )

1. □ 馬來西亞教育文憑(SPM): _________A(s), Chinese Language Subject: ______
□ A 水平(A Level): _________A(s)
□ 馬來西亞高級教育文憑(STPM) CGPA: __________/ or _________A(s), Chinese Language Subject: ______
□ 獨中統考(UEC): _________A(s), Chinese Language Subject: ______
□ 或(or) 其他學歷資格 Other academic qualifications: ___________
2. 家長/監護人去年總收入
Parents/ Guardian’s Last Year Total Annual Gross Income: _________________________

3. 曾獲獎項/ 其他資格 Academic Awards / Other achievements :

________________________________________________________________________________________________

________________________________________________________________________________________________

4. 課外活動 Extra-Curricular Activities：

________________________________________________________________________________________________

_______________________________________________________________________________________________

只供公司用途
For Office Use
申請表格收件日期: 所需文件 (Documentation Required):
Date Application Received: □ Photocopy of result: SPM/ STPM/ or other equivalent certificates: ____
□ Latest Form J (Income Tax Return) or EA Form or Pay Slip or Self-Assessment

□
Form of Applicant's parents/guardian.
Complete set of documentation.

是否受邀出席面試: □ 是(Yes) □ 否(No) 備註(Remarks):

Recommended for interview :

評審簽名
Authorized signatory of Selection Panel

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 照片 星洲日報教育基金
星洲日報教育基金
Recent Sin Chew Daily Education Fund
Photograph
獎學金申請表格
(1 copy)
Application Form

申請科系 科系編號 大學/學院名稱

(Course Applied For) (Course No.) (Name of University/ College)
________________________ ________ __________________________

本人以下列成績提出申請/This application is based on the following result (please tick):

□馬來西亞教育文憑 SPM
□A 水平 A Level
□馬來西亞高級學校文憑 STPM
□獨中統考成績 UEC
□其他同等資格考試文憑 Other equivalent qualifications：______________________________
A. 個人資料 (Personal Data)
姓名(如身分證所示): (英) (中):
Full Name (as shown in IC)

住宅地址 (Home Address):

______________________________________________________________________________________________
_____________________________________________________________郵政編號(Post Code):_______________
住家電話(House Tel): __________________手機 (Handphone No):_____________________
電郵 (E-mail Address): _________________________________________________________

國籍: 種族: 宗教:

Nationality: Race: Religion:

新身分證號碼: 出生日期 (日/月/年): 性別: 男 女

New IC No.: Birth Date: Sex:

婚姻狀況: □單身 □已婚 語言能力 Languages

書寫 口語 1)
□ □ Married
Marital Status: 1)
Single Written: 2) Spoken: 2)

此獎學金并非現金，
此獎學金并非現金，而是各參與的高等院校提供的免費學術課程（
而是各參與的高等院校提供的免費學術課程（包括學費及/
包括學費及/或各種可能的相關費用）。
或各種可能的相關費用）。
This scholarship award is not cash award but will be in the form of academic courses to be offered by
B. 教育程度
the participating colleges / institutions of higher
such other incidental expenses fully paid up.
learning / universities with the tuition fees and / or
(Educational Qualifications)

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 馬來西亞教育文憑 SPM
學校名稱及地址:
Name and Address of School:

考試年份:
Year Taken:
科目 Subject 等級 Grade 科目 Subject 等級 Grade

A Level
學校名稱及地址:
Name and Address of School:

考試年份: 成績等級: 總學分:

Year Taken: Overall Grade: Aggregate:

科目 Subject 等級 Grade 科目 Subject 等級 Grade

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 馬來西亞高級學校
馬來西亞高級學校文憑
學校文憑 STPM
學校名稱及地址:
Name and Address of School:

考試年份: 總學分:
Year Taken: Aggregate:

科目 Subject 等級 Grade 科目 Subject 等級 Grade

獨中統考 UEC
學校名稱及地址:
Name and Address of School:

考試年份: 總學分:
Year Taken: Aggregate:

科目 Subject 等級 Grade 科目 Subject 等級 Grade

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 曾獲獎項/
曾獲獎項/ 其他資格 Academic Awards / Other Qualifications
C.

日期 考試名稱/ 獎項 成績/ 獎狀
Date Name of Examination / Award Grade/ Award

D. 課外活動 Extra-Curricular Activities

No 團體/學會 Associations/ Societies 年份 Year 職位 Position

工作經驗 Work Experiences

E.

僱主名字/地址 (Name and Address of Employer) 職位 (Designation) 期限 (Period)

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 健康狀況 (Health Condition) F.

健康近況﹐若有疾病或任何殘疾﹐請在此注明。
(Please state present health condition, details of any illness, disability or incapacity.)

G. 申請理由 (Reason(s) for Application)

請說明申請理由。
(Your reason(s) for this scholarship application.)

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 H. 家庭背景 Details of Family Background
父親 (Father) 母親 (Mother)
姓名 (中) (中)
Name
(英) (英)
身分證號碼 (新) 年齡: (新) 年齡:
IC No. (舊) Age: (舊) Age:
住家地址
Home Address ________________________________________ ______________________________________
________________________________________ ______________________________________
郵政編號 (Post Code): _________________ 郵政編號 (Post Code): ________________
電話 (Tel) : ____________________ 電話 (Tel) : ____________________
手機 (Handphone): ____________________ 手機 (Handphone): ____________________
職業
Occupation:
僱主姓名
Name of
Employer
僱主地址
Address of ________________________________________ ______________________________________
Employer
________________________________________ ______________________________________
郵政編號 (Post Code): _________________ 郵政編號 (Post Code): ________________
電話(Tel): ____________________ 電話 (Tel) : ____________________
傳真(Fax): ____________________ 傳真(Fax): ____________________

I. 監護人 Guardian (若有

(若有)
若有)
姓名 (中) 身分證號碼 (新) 年齡:
Name IC No. (舊) Age:
(英) 職業
Occupation
住家地址
Home _____________________________________________________________________________________
Address
______________________________________________郵政編號 (Post Code): _________________
電話 (Tel) : ____________________手機 (Handphone): ____________________

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若家長/
若家長/監護人是自僱者，
監護人是自僱者，請提供以下資料 (Details of Parents’/Guardian’s Own Business):
公司/生意名稱及地址: 生意性質: 經營時間有多久?
Name and Address of Business Business Nature: Establishment of Business

_______年 (years)
______個月(months)
電話 (Tel):
傳真 (Fax):
生意是否全盤已有? □是 □否 若與人合伙，請說明家長/監護人所擁有的股權
Is the business wholly owned? Please state share held by parents/ guardian, if in
partnership or joint venture.

家長/
家長/監護人全年總收入 (去年 (去年)
去年)
Parents/ Guardian’s Last Year Annual Gross Income
父親 (RM) 母親 (RM) 監護人 (RM) 總數 (RM)
Father Mother Guardian Total
受僱
As employee
做生意
Own Business
租金
Rental Income
其他
Others
總數
Total

家庭開銷
Expenditures of Family:
事項 每個月 每年
Items Monthly (RM) Yearly (RM)
房子貸款/租金
House Installments/ Rental
貸款(汽車/電單車/其他裝置)
Loan Repayment (motor vehicles/ appliances, etc...)
水電費/電話費
Electricity/ Water/ Telephone
教育費 共_____位孩子
Education for ____ children
其他開銷
Others expenses
總共
Total

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兄弟姐妹/
兄弟姐妹/受扶養家屬
Names and Particulars of Siblings/ Other Dependents
姓名 關係 年齡 婚姻狀況 職業 全年收入 (RM)
Name Relations Age Marital Occupation Annual Income
Status
(中)
(英)
(中)
(英)
(中)
(英)
(中)
(英)
(中)
(英)
(中)
(英)

J 鑒定者 Referees
姓名: (中) 姓名: (中)
Name Name
(英) (英)
地址: 地址:
Address Address

電話 (Tel): 電話 (Tel):
職業: 職業:
Occupation Occupation

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請附上以下文件影印本:
請附上以下文件影印本:
The following documents must be submitted together with the Application Form:

1. 身分證(雙面)
Identity Card (both sides)

2. 報生紙
Birth certificate

3. 馬來西亞教育文憑/ 馬來西亞高級學校文憑/ 獨中統考成績/ 其他同等資格考試文憑

SPM/STPM/UEC/Other equivalent qualifications.

4. 課外活動記錄和證書
Testimonial(s) and record(s) of participation in extra-curricular activities

5. 家長/監護人最新的收入表(包括稅務回收)/報稅單/自行估稅表格
Latest Form J (Income Tax Return) / EA Form/ Self-Assessment Form of Applicant’s parents/guardian

1. 您是否曾接受獎學金？ □有 (Yes) □無 (No)

Have you been awarded any scholarship before?

如有，請提供以下資料：
If “Yes”, please supply the following information:

年份 大學/學院 科系 獎學金贊助單位
Year University/ College Course Sponsorship unit

2. 您的兄弟姐妹是否曾受益於其他教育基金？ □有 (Yes) □無 (No)

Has any of your siblings (brother(s)/sister(s)) benefited from other education funds?

如有，請填寫以下資料
If applicable, please supply the following information: -

姓名 關係 科系 學院 入學年份
Name Relationship Course College Year
Admitted

3. 您的兄弟姐妹是否也同時申請此獎學金計劃？ □有 (Yes) □無 (No)

Has any of your siblings (brother(s)/sister(s)) applied to this Fund?

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備注: 星洲媒體集團在此申請表格/聲明當中將簡稱為“星洲”。
Recital: Sin Chew Media Corporation Berhad shall hereinafter be referred to as the “SCMCB”.

填寫表格之前﹐請仔細閱讀申請程序及條規。
You are required to read the procedures, requirements, terms and conditions herein below carefully before submitting your
application.

申請程序﹕
Procedures:

所有書信聲明必須書寫整齊或打印清晰。一旦發現申請者虛報資料或刻意隱瞞資料﹐將立即淘汰。所需文件必須隨
同申請一起呈上。截止日期後遲交上來的申請將不被接受。所有申請書必須封在信封裡﹐並在信封左上角注明選擇
科系。
Please note that any false particulars, information, documents, untruthful material facts or misrepresentations will subject
you to disqualification. The application form should be printed out clearly or be written legibly and must be accompanied by
the required documents and must be submitted before the published closing date. Proof of posting is not proof of receipt. The
selected course(s) must be clearly written or printed on the top left hand corner of the envelope. The “Sin Chew Daily
Education Fund” ’s address is as follows:

星洲日報教育基金
截止日期：SPM 成績公佈後的第 14 天或參閱星
Sin Chew Daily Education Fund
Sin Chew Media Corporation Berhad (“SCMCB”)
19 Jln Semangat 洲日報所刊登的最新申請截止日期。
46200 Petaling Jaya Application deadline: 14th day after the
Selangor Darul Ehsan announcement of SPM Result. If not, please refer to

注﹕郵寄憑據不足以做為文件已被接收的證據。 our Sin Chew Daily for the latest deadline.

(Please note that proof of posting is not proof of receipt.)

申請條規 :
Terms and Conditions:

申請者必須符合以下條件﹕
The following terms and conditions shall apply to all applications: -

1. 從 年 月 日算起﹐仍在 歲以下的馬來西亞公民。
2010 1 1 26
The applicant must be a Malaysian citizen below 26 years of age as at 1st January 2010.

2. 在馬來西亞教育文憑/A 水平/馬來西亞高級學校文憑/獨中統考或其他同等考試中考獲優秀成績。
Students must possess good results in SPM/A-Level/ STPM/ UEC or other equivalent qualifications.

3. 活躍於運動和課外活動。
Students must be active in sports and extra-curricular activities.

4. 沒有接受﹐也不受約束於任何學院或機構所提供的輔助金/獎學金。
Students must not be bonded or in receipt of any financial aid or rewards from other educational organisations or
institutions.

5. 在面試期間，獎學金入選者必須提呈正本的文憑。
The applicants must produce original copies of the examination results and all other relevant documents during the
interview.

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6. 評審團選出的結果是最後的決定，任何有關要求或投訴，恕不處理。
The selection committee’s decision in all matters pertaining to the selection of the scholarship award is final and no
appeal, inquiry or correspondence will be entertained.

7. 學生必須達到學院/大學所規定的成績標準，才有資格被獲選獎學金的機會。
Students must meet the minimum requirement set by the Colleges/ Universities in order to be qualified for selection.

8. 各學院、大學及課程都有不同的入學資格，申請者可直接向有關的學院、大學查詢。
Different colleges, universities and courses have different entry requirements. Please liase directly with the colleges or
universities concerned for more details.

9. 學生不能在修讀有關課程期間，未經“星洲”或大學／學院允許放棄、中斷或轉換課程、工作或兼職，除非有
關的工作是有關課程的一部分。
The recipient is not to discontinue or switch Course or to take up any full or part time employment while pursuing the
said Course without the prior written approval of “SCMCB” or The College/ University concerned unless such
employment is part and parcel or related to the said Course

10. 學生不能參加、參與、涉及任何“星洲”或大學／學院認為會羞辱有關深造國家或大馬的活動或團體組織，或
者進行任何深造國家或大馬法律所嚴禁的不法活動。
The recipient is not allowed to participate in any form of illegal activity or join any unlawful organisations which in the
opinion of “SCMCB” or The College/ University would embarrass or cause disrepute to all parties concerned
throughout the study period.

11. 學生必須全程修讀、準時上課、用功及不缺席（除非生病或短暫身體殘障）任何有關課程所指定的講課、指導
課和課程。
The recipient is to attend all classes, lectures, tutorials and lessons as required by the said Course regularly and
diligently unless he or she is medically unfit to do so.

12. 學生必須實踐良好行為並跟隨學院／大學所規定一切規則和法規。
The recipient is required to obey all rules and regulations of the participating College/ University at all time and is
expected to conduct himself/herself in a respectable manner.

13. 有關學院／大學及“星洲”不需負任何義務在學生修讀期限屆滿後必須延長有關獎學金。
The participating College/ University and “SCMCB” are not obligated to extend the award beyond the existing
academic period.

14. “星洲”有權增刪以上的規則，而不另行通知。任何異議，恕不處理。
“SCMCB” reserve their right to add or amend the rules and regulations contained herein without prior notice. No
complaint whatsoever shall be entertained.

15. 有關獎學金并不是由“星洲”直接供給。而是通過星洲日報來接領其他贊助商/高等學府/企業機構﹑個人或團
體所提供的獎學金或助學金。學生在有必要時，必須與提供獎學金單位或贊助人簽署合約。
The awards are not directly offered by “SCMCB” but are offered by the participating educational institutions or other
sponsors through “SCMCB” and the recipient may be required to sign a bond directly with the participating Colleges/
Universities if required to do so.

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 申請者聲明書
APPLICANT’S DECLARATION

1. 本人在此證實﹐所有遞交上來的文件及申請書內所填各欄皆確實無誤。若有任何虛報或隱瞞之處﹐主辦當局或“星洲”有
權對本人及推薦人採取行動﹐撤銷已發放的獎學金及追討有關已發放款項﹐並可索取由本人造成的損失。
2. 本人保證將用功求學﹐務求在最短的時間內完成學業﹐並定期向主辦當局或“星洲”呈報最新發放的學期成績﹑學費以及
雜費收據。
3. 本人認可﹐倘若接領的獎學金並非由“星洲”資助﹐而是由其他通過或“星洲”發放助學金的贊助商/教育機構/企業/個人
或集團﹐一旦發生任何狀況﹐如有半途中斷或撤銷助學金或有任何差異之類的情況發生﹐“星洲”將不負以上任何法律責
任。本人及家長及監護人也同意放棄對“星洲”採取任何法律行動的權力。
4. 本人須履行獎學金合約上的規章﹐並提供主辦當局合適的擔保人或任何保證聲明﹐以及簽署並履行任何獎學金保證合約。
5. 本人證實已悉閱所有規章﹐並同意遵守本規章。
6. 我謹繼續表明我完全了解有關獎學金，若獲“星洲”頒授，並非現金，而是學院／大專院校的學術課程已包括學費及／或
可能有其他相關費用。
7. 我謹同意若本合約內容的中英文版本出現意思上的衝突，應以英文版本的意思為準，並作為主要和基本的詞意解釋用途。

1. I declare that the information given herein are true and accurate to the best of my knowledge and belief. If at any time hereafter such
information are found to be untrue or false or misleading due to willful neglect, “SCMCB” shall be at liberty to take actions against
me, including the withdrawal of any benefit already granted to me and the recovery of all losses sustained by “SCMCB” or such
further actions deem fit and proper by “SCMCB”.

2. I agree that the award is not a direct grant of “SCMCB” but is granted by the participating Colleges/ Universities through “SCMCB”
and as such any failure to honor the scholarship award by way of discontinuance, termination, suspension or variation by the college
or the university concerned shall not be the fault or liability of “SCMCB” and I agree that no legal actions whatsoever shall be taken
against “SCMCB” by me and/ or my parents or guardian(s).

3. I agree to complete the course of study within the stipulated time and to furnish my progress reports or examination results as may be
requested by “SCMCB” from time to time.

4. I understand that I may be required to sign a bond document or to provide security or surety prior to the award of the said scholarship.

5. I confirm, accept and agree to be bound by all the terms and conditions as stated in this application.

6. I further declare that I am fully aware that the scholarship award, if granted by “SCMCB”, will not be in the form of cash award but
will be in the form of academic courses to be offered by the participating colleges and/ or institutions of higher learning with the
tuition fees and/ or such other incidental expenses included.

7. I agree that in the event of conflict between the Chinese and English versions as stated in this application, the English version shall
prevail and shall be the principal and primary text of interpretation.

姓名 身分證號碼
簽名 日期
Name of Applicant __________________________ I/C No ________________________________

Signature of Applicant _________________________Date _______________________

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