Scholarship Programme 2013 - Application Form

The Hong Leong Foundation Scholarship Programme is open to all Malaysian citizens who have an excellent academic record, active in extra-curricular activities but financially challenged

Photo

Complete ALL sections LEGIBLY in BLOCK LETTERS (including the Summary section below). All details are deemed extremely important for our evaluation purposes. Please provide complete details and supporting documents. Please also make sure that you read and understand the FAQ listed in http://hongleongfoundation.org/scholarship

Summary of Application (VERY IMPORTANT - must be filled in by applicant):

Please do not proceed if you are applying for a university / college preparatory course like FOUNDATION, any PRE-U PROGRAMME, etc.

Diploma/Advanced Diploma
st

Undergraduate

Indicate the number of As, Bs & Cs or CGPA achieved for: SPM: A+ ___ A ___ A- ___ B+ ___ B ___ C+ ___ C___ D ___ STPM / A-LEVEL / Matriculation: CGPA _____ OR A ___ B ___ C ___ Foundation / Diploma / Degree: Latest CGPA / GPA _____

Field of Study (1

choice):

..

Institution / University (1st choice): ..

Instructions: a) It is the responsibility of the applicants to ensure that testimonials & certified true copies of supporting documents are attached ( see the checklist). b) Please state, on a separate sheet of paper, why you deserve this scholarship, in 200 words or less. c) Only shortlisted applicants will be notified. d) Only applications with full documentation will be considered. e) The completed application form should be returned to: The Hong Leong Foundation Scholarship Programme, c/o Level 3, Wisma Hong Leong, Closing Date : 10 May 2013 18 Jalan Perak, 50450 Kuala Lumpur

PERSONAL PARTICULARS: Name (As Per IC):

NRIC NO: Home Address:

Race:

Correspondence Address: (if different from above)

Tel No: (House) Date of Birth:

Day Mth Year

Tel No: (Mobile) Gender (please ):

Male Female

E-mail Address: PROPOSED FIELD OF STUDY (VERY IMPORTANT): Type of scholarship applied (please ): DIPLOMA/ADVANCED DIPLOMA Field of Study 1st Choice 2nd Choice 3rd Choice

UNDERGRADUATE Duration (years)

College/University

ACADEMIC QUALIFICATIONS: (Please provide certified copies of results/certificates) Year Name of Institution/School Exam/Qualification Attained Attained

Grade/Score

EXTRA-CURRICULAR ACTIVITIES: Details of extra-curricular activities/responsible positions held in school/college & key learning points: (Please continue on separate sheet, if required) Position Held & Club School/College Key Learning Points (i.e. what youve learned from this) 1. 2. 3. 4. DETAILS OF IMMEDIATE FAMILY: (Please enclose a photocopy of latest JForm, salary slips or Pension card ) (Details about your parents, brothers and sisters. Please continue on separate sheet, if required). *Annual Occupation Name Relationship Age (if in school or employed, name & address of school or employer) Income 1. Father 2. Mother 3. 4. 5. 6. 7.
* Denotes regular salary, side-income, earnings from part-time job, pension, interests from savings, dividends from stock investment or any other form of income that is being used to support the family. Please be very truthful.

Please state any other facts/information you may wish to advance in SUPPORT of your application (e.g. demise of breadwinner in the family, etc.). Please let us know if you have physical disability, impairment, medical / health condition so that we will give special consideration to your application

How did you learn about the Hong Leong Foundation Scholarship Programme? (please ):

Newspaper

Friends By Mail

Internet

Others..

Where did you obtain the Hong Leong Foundation Scholarship Programme application form? (please ):

Download from website

Hong Leong Bank Berhad (please specify branch).

I hereby confirm that the information given above is true and accurate, and that I am currently not receiving any other scholarship funding. I understand that any misrepresentation of facts given herein will be sufficient cause for termination of the scholarship if approved.

Date:

Applicants Signature:

CHECKLIST:
PMR Results SPM / STPM / Matriculation Results Foundation / Diploma / Degree Results GCE O Level 1119 English results (if available) Extra Curricular Activities Reports/Certificates 200-word Essay Testimonial (from a non-family member) Letter of Offer from College/University (if available) Parents income level (e.g. Salary slip, income tax form (Form J), etc.) - IMPORTANT Other Relevant documents (please specify):