Please affix a recent

passport size
photograph here
OCBC PUBLIC SCHOLARSHIP
APPLICATION FORM

PERSONAL INFORMATION

Full Name (As per IC) Telephone/

Mobile No.
Gender Marital Status
(Single/Married)

Permanent Address

........
...................................................................................

Date of Birth Place of Birth

(DD/MM/YY)
Nationality Identity Card No.

Do you have any physical disability or handicap?

Yes No

If yes, please specify: ..

FINANCIAL POSITION

FATHER
Full Name (As per IC) Age

Occupation Name of Employer

MOTHER
Full Name (As per IC) Age

Occupation Name of Employer

April 2016
FAMILY INCOME
Please indicate below the amount of income earned by each member of your family. Family members include
father, mother, brothers and sisters.

Total Monthly Contribution to

Full Name Relationship Occupation
Income Family
(RM) (RM)

What is the estimated monthly expenditure of your family? RM

Please list below all family dependents

Full Name Relationship Age

Do any of your family members own properties or have a share in any business? If yes, please specify.

...............
..

Please state the types of bursary, scholarships or financial grants and their values which you are currently in
receipt, if any.

1. .
2. .
3. .
4. .

ACADEMIC BACKGROUND
List below, in reverse chronological order, each educational institution you have attended and the highest level of
examination passed. You must enclose photocopies of all academic transcripts.

Dates (Year)
Educational
Institution From To Exam Passes / Grades Obtained
(Most Recent)

List below any scholastic awards and honours you have obtained in schools and/or universities.
April 2016
 Award / Honour Year

LEADERSHIP ACTIVITIES
List below all leadership activities in which you have actively participated (Academic / Sports / Community).
You may also include other relevant and important activities if any.

Types of Activities Position and Responsibilities Year

HOBBIES AND INTERESTS

List below your hobbies, interests and other social activities. You may also include information about other
relevant and important activities if any.

1. ..
2. ..
3. ..
4. ..

UNIVERSITY ADMISSION
List below your intended course of studies and the universities you have applied to (in order of preference).

Name of University Field of Study

First Choice

Second Choice

Third Choice

REFERENCE
List below the names and information of TWO referees who are not related to you. One of the referees must be
competent to share on your previous academic achievements.

Name Telephone Occupation / Place of Work

April 2016
OTHER INFORMATION

Why are you interested in getting an OCBC Scholarship?

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..
..
..
..
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.

What are your career goals?

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DECLARATION

I authorise investigation of all statements and attachments contained in my application for an OCBC
scholarship. I fully understand that a misrepresentation or omission of facts will be sufficient cause for
cancellation of consideration or withdrawal of the said scholarship if my application is successful.

Signature Date
Name

April 2016