Sunway University College

A-Level Scholarships
Application Form Please attach
passport size
photo here

A. Personal Particulars (Please use BLOCK LETTERS)

Full Name (as per IC)

IC No.

E-mail Address

Home Address

Postcode Town State

Home / Permanent Tel No. Mobile Phone No.

Gender Male Female Date of Birth Nationality Race

B. School / Institution

Name of School

Address

Contact No.

C. Details of Parents / Guardian (Please use BLOCK LETTERS)

Name of Father (as per IC / Passport) IC / Passport No.

Occupation

Company / Organisation Name

Company / Organisation Address

Office Tel No. Mobile Phone No.

Name of Mother (as per IC / Passport) IC / Passport No.

Occupation

Company / Organisation Name

Company / Organisation Address

Office Tel No. Mobile Phone No.

Are your parents financing your studies? Yes No

If not, please specify below

Name of Guardian (as per IC / Passport) IC / Passport No.

Occupation

Company / Organisation Name

Company / Organisation Address

Office Tel No. Mobile Phone No.

Checklist for documents to be enclosed

Completed application form Certified true copies of examination results
One (1) passport-size photograph • Form 4 mid-year and final examination results (as per report card / book / school report)
• Form 5 mid-year examination results
One (1) copy of of Identity Card
D. Academic Qualifications

No. Subject Mid-Year Exam Results Final Exam Results Mid-Year Exam Results
Form 4 (2009) Form 4 (2009) Form 5 (2010)
Marks Grades Marks Grades Marks Grades
Bahasa Malaysia
English
Mathematics

Note: Please attach a Certified True Copy of your actual results and report card / book

E. Extra-Curricular Activities (Please complete this section in detail. You may attach a separate sheet, if required)

No. SPORTS / SOCIETIES / CLUBS / UNIFORMED BODIES Position Held Year

1.
2.
3.
4.
5.

No. OTHERS (eg. Prizes / awards won such as academic / subject / prizes, trophies, Year
medals for sports / other competition)
1.
2.
3.
4.
5.

Note: Please attach a Certified True Copy of certificates of ECA achievements with this application form

F. Submission Instructions
Submission deadline is by 5.00pm on 13th August 2010.
The application is to be mailed, couriered or handed in to:
Sunway University College A-Level Scholarships 2011
c/o Marketing Department
No. 5, Jalan Universiti, Bandar Sunway
46150 Petaling Jaya, Selangor Darul Ehsan

G. Declaration by Applicant

I, the undersigned, declare that the particulars provided by me in this application form are correct, and that I have read, understood and agree to abide
by the Terms and Conditions of the Sunway University College Cambridge A-Level Scholarships. I understand that the scholarship will be withdrawn if
any information provided in this form is found to be inaccurate, fraudulent or in contradiction to the Terms and Conditions of this scholarship.

Signature of Applicant Name of Applicant (as per IC) Date