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HIGH ACHIEVER’S SCHOLARSHIP APPLICATION FORM
Programme Applied: (1) Personal Details: Student ID: (existing student) IC No.: Date of Birth: Nationality: Race: Home Address: Sex: Tel. No.: (House) Mobile Phone: Email address: (2) Educational Background: Name of School(s) Date Joined Date Left Qualification Attained Intake:
Name:
Correspondence Address:
(3)
Examination/Academic Results (SPM/STPM/UEC): ______________ Year Graduated: ____________ Subject Grade Subject Grade
SB/HAS/AF/v.2/2013
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(4) Other Qualifications (Please provide details): Qualification Grade/Results
(5) No. 1 2 3 4
Extra Curricular Activities: School/State//National Verification by Principal/HEM
(6) No. 1 2 3 4 5
Awards, Commendations, Prize, Certificates Achieved: Type of Awards Year
(7) Please indicate the reason for applying this scholarship through a letter (500 words). (8) Parent/Guardian: Name Relationship Occupation
I declare that the information provided by me in connection with this application is true and correct. I understand and agree that SEGi Scholarship Board reserves the right to vary or reverse any decision regarding this application made on the basis of incorrect or incomplete information. I also agree to abide by all terms and conditions as stated. Signature:
Date: Name: IC No.:
SB/HAS/AF/v.2/2013
2
Instructions: Please attach the following supporting documents: Certified copies of Identity card (both sides) Certified copies of academic certificate(s) and transcripts Certified copies of documents indicating sports/extra-curricular activities Letter indicating the reason for applying this scholarship.
And submit the application to: SCHOLARSHIP BOARD SEGi University College No.9, Jalan Teknologi, Taman Sains Selangor, Kota Damansara, PJU 5, 47810 Petaling Jaya, Selangor D.E.
For enquiry, please contact: Tel. No.: 03-6145 1777 Fax No.: 03-6145 2673 Email: [email protected]
FOR OFFICE USE Date received: Date of interview: Application No: Intake: SUC/HAS/_____
Approval Status: Remarks:
Approved
Rejected
SB/HAS/AF/v.2/2013
3
HIGH ACHIEVER’S SCHOLARSHIP APPLICATION FORM
Programme Applied: (1) Personal Details: Student ID: (existing student) IC No.: Date of Birth: Nationality: Race: Home Address: Sex: Tel. No.: (House) Mobile Phone: Email address: (2) Educational Background: Name of School(s) Date Joined Date Left Qualification Attained Intake:
Name:
Correspondence Address:
(3)
Examination/Academic Results (SPM/STPM/UEC): ______________ Year Graduated: ____________ Subject Grade Subject Grade
SB/HAS/AF/v.2/2013
1
(4) Other Qualifications (Please provide details): Qualification Grade/Results
(5) No. 1 2 3 4
Extra Curricular Activities: School/State//National Verification by Principal/HEM
(6) No. 1 2 3 4 5
Awards, Commendations, Prize, Certificates Achieved: Type of Awards Year
(7) Please indicate the reason for applying this scholarship through a letter (500 words). (8) Parent/Guardian: Name Relationship Occupation
I declare that the information provided by me in connection with this application is true and correct. I understand and agree that SEGi Scholarship Board reserves the right to vary or reverse any decision regarding this application made on the basis of incorrect or incomplete information. I also agree to abide by all terms and conditions as stated. Signature:
Date: Name: IC No.:
SB/HAS/AF/v.2/2013
2
Instructions: Please attach the following supporting documents: Certified copies of Identity card (both sides) Certified copies of academic certificate(s) and transcripts Certified copies of documents indicating sports/extra-curricular activities Letter indicating the reason for applying this scholarship.
And submit the application to: SCHOLARSHIP BOARD SEGi University College No.9, Jalan Teknologi, Taman Sains Selangor, Kota Damansara, PJU 5, 47810 Petaling Jaya, Selangor D.E.
For enquiry, please contact: Tel. No.: 03-6145 1777 Fax No.: 03-6145 2673 Email: [email protected]
FOR OFFICE USE Date received: Date of interview: Application No: Intake: SUC/HAS/_____
Approval Status: Remarks:
Approved
Rejected
SB/HAS/AF/v.2/2013
3
