YSD - UPM POSTGRADUATE SCHOLARSHIPS FORM

A. PERSONAL PARTICULARS

PHOTOGRAPH

Full Name as per IC/Passport

New IC No. − −

Date of Birth
Place of Birth
(DD.MM.YYYY)

Gender Age

Race Nationality

Religion

Marital Status Single Married Divorced Widowed

Contact Details
Telephone No. (Home)

Telephone No. (Mobile)

Email Address

Mailing Address

Unit No. and Street

Town/City Postcode

State Country

B. FAMILY BACKGROUND

FATHER/ GUARDIAN MOTHER/ GUARDIAN

Name:

NRIC No:

Date Of Birth:

Occupation:

Monthly Income:

Employer Name &

Address:

Permanent Address:

Office Tel.No.:

Mobile Phone No:

Home Tel. No.:

* If guardian, please
specify the relationship:

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 SIBLINGS

Name Level of Education Occupation Age Name of School / Institute / Employer

C. ADDITIONAL INFORMATION

Do you have any family members / relatives working in the Sime Darby Group? Yes No

If Yes, please provide the following details

Name Relationship Company Location Designation

D. LANGUAGES AND DIALECTS PROFICIENCY

Languages / Dialects Read Speak Write

Bahasa Malaysia

English

Mandarin

Tamil

Others:

Others:
Language Proficiency: (0 worst - 10 best)

E. EDUCATIONAL AND QUALIFICATIONS PARTICULARS

Location Qualification Date (DD.MM.YYYY)

Discipline/ Field of
Name of Institution/ University/ School (Country / (i.e.SPM or Final Results/ Achievement
Study
Town / City) STPM) From To

DETAILS OF FURTHER EDUCATION COURSE (S) PURSUED AT PRESENT (if any)

Date (DD.MM.YYYY)
Location (Country/ Qualification Sought
Name of Institution/ University/ College Discipline/ Field of Study
Town/ City) From To (i.e. Degree, Dip.)

ACADEMIC AWARDS

Name of Award Year Particulars of Award

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F. EXTRA-CURRICULAR ACTIVITIES

Please specify your top five sporting achievements that you are proud of, if any.

Level
Position
Sports Year (e,g:School, District, State,
(e.g: President, Secretary )
National, International)

Please list down your top five positions that you have held in societies, if any.

Level
Society / Club Year Position Held (i.e. President, Secretary, Committee) (e,g:School, District, State,
National, International)

G. CHOICE OF UNIVERSITIES AND FIELD OF STUDY

First Choice Status (Please tick (√) the box below)

UNIVERSITY Not yet applied Received offer, not yet enrolled

FIELD OF STUDY Applied, yet to receive offer Enrolled

Second Choice

UNIVERSITY Not yet applied Received offer, not yet enrolled

FIELD OF STUDY Applied, yet to receive offer Enrolled

H. OTHER SCHOLARSHIPS

Provide details of any bond, scholarship or financial assistance received (e.g duration of bond amount etc.) in the past.

List other scholarships you are applying to at the moment (this information will not be used to prejudice your application)

Declaration
Have you ever been charged or convicted for the violation of any law, excluding minor traffic offences? (Yes/No)
Have you ever been charged of drug abuse or any other illegal substance under Malaysian law? (Yes/No)
Are you diagnosed with any illnesses, diseases or disorders? (Yes/No)

I hereby certify that the information provided by me above are complete and correct to the best of my knowledge;
I understand that any false statements or witholding of any relevant information may provide grounds for the withdrawal of any offer of scholarships or for
its immediate cancellation if the scholarship has been accepted;
I understand that my application may be disqualified in the event that I have not attached all supporting documents mentioned in the checklist below.

SIGNATURE OF APPLICANT DATE

Checklist (Please Tick)

1. All details provided in the application form are valid

2. Supporting Documents:
Note: Before you submit, please ensure that the following documents have been "certified true copy"
(a.) Resume
(b.) One (1) passport size photograph (full name and IC number to be written at the back)
(c.) Photocopy of IC – Personal
(d.) Photocopy of IC – Biological Father / Stepfather / Guardian
(e.) Photocopy of IC – Biological Mother / Stepmother / Guardian
(f.) Copy of SPM slip + Any other recent results
(g.) University Offer Letter / UPU application (if applicable)
(h.) Letter of confirmation for start & end date from university – To those who already enrolled at the university
(i.) Parents pay slip / Income declaration / Pension statement / Certificate of Death / Certificate of Divorce
(j.) Offer letter of other financial assistance received i.e PTPTN, MARA, JPA
(k.) OKU Card – For Special Needs candidate only
(l.) Bank Details Form & Copy of front page of bank account / Statement of account – The document attached in this email
(m.) PDPA Form