AMCHAM MACEE Scholarship Form1

The American Malaysian Chamber of Commerce (AMCHAM)
and the Malaysian-American Commission on Educational Exchange (MACEE)

are pleased to announce the competition for the AMCHAM-MACEE Scholarship. This scholarship is open to
qualified Malaysian students who have been accepted to an accredited American university for the Fall of 2014 for
four years of study culminating in a Bachelors degree. The scholarship application deadline is May 30, 2014.

AMCHAM supports member business interests and Malaysian economic growth through proactive and effective
representation, communication and information sharing. This mission is achieved by developing mutually beneficial
relationships and ongoing programs and dialogues among its members and the governments of Malaysia and the
United States of America.

MACEE is one of 50 binational Fulbright Commissions worldwide and is the home to an advising center which is the
authoritative source in Malaysia for information on U.S. education. MACEE is administering this scholarship
program and is available to answer questions from interested students and parents. We are located at:
18
th
Floor, Menara Yaysan Tun Razak,
200, Jalan Bukit Bintang,
55100 Kuala Lumpur, Malaysia
Tel: (03) 2166-8878, Fax: (03) 2166-1878

Scholarship eligibility
The AMCHAM-MACEE Scholarship will provide AMCHAM funding to a qualified Malaysian student who has been
admitted into a U.S. university for the Fall 2014 semester. The student must be a freshman applicant who has not
previously enrolled in a college or university degree program. Selection will be based upon academic merit and
leadership potential. The scholarship is a partial scholarship (5,000 USDper year) and is renewable annually for
four years subject to maintaining the required Grade Point Average at the U.S. University where the student is
enrolled.

How to Apply for the Scholarship
1. Submit two complete application forms with all required documents: (I) post one hard copy with all required
documents to MACEE (see above address) and (II) email one electronic version with all required documents to
EducationUSAMalaysia@gmail.com by or before May 30, 2014.
2. The required documents to be sent with the application form include all of the following:
a. Secondary school transcripts (exam results) certified as true copies from Form 3 or 9
th
Grade up to the
most current level of education completed.
b. School Leaving Certificate and Testimonial translated (if not in English).
c. TOEFL scores.
d. SAT/ACT scores, IF the scores are required by the U.S. University you are applying to.
e. One teacher reference and one community reference. Use the forms provided with the application
form for the AMCHAM-MACEEE Scholarship. The community reference should be completed by a community
or religious leader who has supervised you in volunteer work done over a period of time.
Please note: It is your responsibility to provide both the teacher and the community recommender with
a stamped and addressed envelope to be sent to MACEE as well as the email address:
EducationUSAMalaysia@gmail.com for the electronic version to be sent to MACEE.
g. A copy of your Malaysian IC.
h. A copy of the letter of acceptance/letter of offer from the U.S. University you plan to attend in Fall 2014.
i. A copy of the I-20 Form from the U.S. University you plan to attend Fall 2014.
Please note: Since scholarship applications must reach MACEE by May 30, 2014, you may apply without
the I-20 Form, but as soon as you receive the I-20 Form from the U.S. University you will attend in Fall
2014, you must submit a copy to MACEE by post and electronically.
j. Financial documentation

AMCHAM-MACEE SCHOLARSHIP 2014

AMCHAM-MACEE Scholarship

I. Personal Information

Legal Name:
Click here to enter text.
Usually Called:
Gender: Male Female
Telephone:
Enter text.
Email:
IC Number:
Enter text.
Birthdate:
Click.
Age:
Type here.

Permanent Home Address:

Are you currently residing in your Permanent Home Address? Yes No

If you checked No, enter your current address here:

II. Academic Information

Enclose official transcripts from each secondary school attended. Include official certified copies translated into
English of your final exam.

Secondary School:
Type name of school here.
Address:
Type address of school here.

SPM O Level/IGCSE IB Other: Please specify. Date Completed: Select a date.

Post-Secondary/Pre-University:
Type name of school here.
Address:
Type address of school here.

STPM A Level IB Other: Please specify. Date Completed: Select a date.

APPLICATION
CHECKLIST
( ) Application Form
( ) School Exam Results
( ) Sch. Leaving Certificate
( ) TOEFL _________
( ) SAT ___________
( ) Letter of Acceptance
( ) I 20
( ) 2 Letters of Reference
( ) Malaysian IC
( ) Financial Documents

III. Standardized Testing

List all dates on which you took the following tests:

Test Date Registered Test Date Score
TOEFL
Click here. Click here. Enter text.

SAT I or ACT
Click here. Click here.
Verbal: Enter text.
Math: Enter text.
Writing: Enter text.

SAT II SUBJECT TEST
Subject: Enter text.


IV. Additional Information

To which colleges and universities have you submitted applications?

1. Type here. 4. Type here.

To which colleges and universities have you been accepted?


V. Personal, Community and School Activities
List your most important school, enrichment, community or other activities in the relevant sections below in order of
most importance. Include specific major accomplishments and leadership positions held, etc.

School Co-Curricular Months per year Hours Per Week Office(s) held or honor(s) received

1.

Type here. Type here. Type here. Type here.
2.

3. Type here. Type here. Type here. Type here.
5.

Note: Enrichment courses include training/coaching outside of school (such as, music, sports, public speaking, etc).

Enrichment Courses Years/Months of Involvement Hours Per Week

1.

Type here. Type here. Type here.
2.

3.


Note: Community activities refer to any volunteering activity, unaffiliated with your school.

Community/Volunteer Work Years/Months of Involvement Hours Per Week

1.

2.

3.

VI. Work Experience
List any job you have had in the past three years, including summer employment.

Specific Nature of Work Employer Dates Hours Per Week

1.
VII. Family and Financial Information

Number of People in Family:
Enter text. Number of People Currently Living at Home: Enter text.

Please fill in information for all household members (excluding parents) in the space provided below and indicate
their relationship to applicant (eg. Self,siblings, grandparents, maid, uncles/aunts, etc).

Name Age Position/Occupation Name of School/Workplace

1.
Name & Relationship to Applicant. Type Enter text here. Enter text here.
2.
3.
4.
5.
6.
Financial Information must be submitted for BOTH father and mother as well as for other sponsors, if there are
any. If your parent(s) is/are not currently earning an income, please fill in each item based on the last position held.
Any person partially/fully funding the applicants education will be referred to as a Sponsor.
currently employed: submit most recent income tax return and annual salary statement from the employer
retired: Submit annual income tax or annual salary statement for the last 2 years of working life before
retirement and current income from all sources such as employment, pension, annual retirement benefits,
investments, rental income, etc.
If there are multiple Sponsors, supply separate financial records for all sponsors. Please note that applications
cannot be processed until a complete set of financial records are submitted for all Sponsors. If necessary, fill in
several sponsors information in the form as shown below.

Father Employed Retired Unemployed Deceased Divorced

Full Name:
Name of Father or Guardian. (If Guardian, please indicate your relationship).
Address:
Enter text.
City:
Enter text.
State:
Enter text.
Postcode:
Enter text.
Occupation:
Enter text.
Annual Income:
Enter text.
Name of Company/Business:
Enter text.
Telephone:
Enter text.
Fax:
Enter text.
Email:
Enter text.

Mother Employed Retired Unemployed Deceased Divorced

Full Name:
Name of Mother or Guardian (If Guardian, please indicate your relationship).
Address:
Enter text.
City:
Enter text.
State:
Enter text.
Postcode:
Enter text.
Occupation:
Enter text.
Annual Income:
Enter text.
Name of Company/Business:
Enter text.
Telephone:
Enter text.
Fax:
Enter text.
Email:
Enter text.
Other Sponsor(s)

Sponsor(s) Name: Name of Sponsor 1; Name of Sponsor 2; etc.
Sponsor(s) Business/Profession: Sponsor 1s Business/Profession; Sponsor 2s Business/Profession; etc.
Sponsor(s) Annual Income: Sponsor 1s Annual Income; Sponsor 2s Annual Income; etc.
Sponsor(s) Relationship to Applicant: Sponsor 1s Relationship; Sponsor 2s relationship; etc.
Sponsor(s) Address: Click here to enter text.
Telephone:
Enter text.
Fax:
Enter text.
Email:
Enter text.

Financial Aid Received from Private Third Parties

Name of Organization/Person: Click here to enter text.

Type of Funding: Grant Loan Scholarship Work Study

Unconditional Merit-based Need-based

Specific Conditions: Please indicate if there are any other conditions for your funding here.

Amount Pledged: Please specify.

Financial Aid Received from University

University Name: Click here to enter text.

Type of Funding: Grant Loan Scholarship Work Study

Unconditional Merit-based Need-based

Specific Conditions: Please indicate if there are any other conditions for your funding here.

Amount Pledged: Place specify.

IX. Affidavit of Support

I, Name of Sponsor , do hereby affirm that I shall provide educational and living expenses for Name of
Applicant as indicated below. I will provide matching funds in the amount of US $ Enter Amount Here for the
applicant for his/her period of study in the United State. I certify that I have sufficient funds to cover this cost.

Signature of Sponsor: ______________________________________ Date: ______/________/________
(dd/mm/yr)

X. Personal Statement

We would like to know more about you personally than what the official documents reveal. The personal
statement is an important part of our evaluation. Describe some event or in your life that you feel helped shape
your development or taught you an important lesson. Please type your statement and put your name and IC
number on the page. Please complete it in no more than 500 words.

XI. Essay

Write an essay of no more than 300 words on the following topic: Define your academic goals and objectives and
explain how this scholarship will help you achieve your goals. Put your name and IC number on each essay sheet
that you submit with your application.

I certify that the information I have given on this application is complete and correct to the best of my knowledge. I
understand that I am responsible for supplying official records from schools I have attended and that such records
become the property of the AMCHAM-MACEE Scholarship and are not returnable to me. I understand that
falsification of my application or records is grounds for immediate cancellation of this scholarship.

Signature _____________________________________________________ Date ______/________/________
(dd/mm/yr)


TEACHERS REFERENCE

Applicants Name: Click to enter text.

TO THE TEACHER: The student named above is applying for the AMCHAM-MACEE Scholarship. Please give us information on
what you think is important about the students academic skills and personal qualities related to leadership potential and
success in university using the form provided. You may add an additional page if you need more space. Your evaluation is not to
be read by the student. Please type your reference and send it to MACEE both an electronic version and a hard copy. Please si gn
the letter and then scan and email it to: adviser.kl@macee.org.my. Then place the letter in the stamped and addressed
envelope provided by the student and post it to MACEE. We are grateful for your assistance.

Evaluation:

1. Describe the applicant with the first words that come to mind.

2. Academic characteristics:

3. How well do you think this student will adapt to university and the college community? Give examples that
illustrate your points.

4. Background information: How long have you known the applicant?

5. List courses you taught the applicant and the grade given.

Name:
School:
Position:
School Address:

Signature __________________________________________________ Date ______/________/________
(dd/mm/yr)

COMMUNITY REFERENCE

Applicants Name: Click to enter text.

Community
Organization:
Name of Community Organization.
Referee:
Name of Referee.
Telephone:
Click to enter telephone number.
Address:
Address of Community Organization.

TO THE APPLICANT: The Community Referee should be unaffiliated with your school curriculum/program. Examples
of community involvement include service provided to the community through a religious organization, a non-
profit/charity organization and other non-government organizations.

TO THE REFEREE: The student named above is applying for the AMCHAM-MACEE Scholarship. Your input is to assist
the selection committee in better understanding the applicant as a person. Your evaluation is not to be read by the
student. Please type your reference and send it to MACEE both an electronic version and a hard copy. Please sign
the letter and then scan and email it to: adviser.kl@macee.org.my. Then place the letter in the stamped and
addressed envelope provided by the student and post it to MACEE. We are grateful for your assistance.

Directions: Please comment on the students personal qualities related to leadership potential and adjusting to
studying in the United States. What can you tell us about his/her maturity, interests, and ability to work with
others? Please feel free to add an additional page if you need more space than what is provided here.

How long, and in what capacity, have you known the applicant?

Signature_______________________________________________________ Date ______/________/________
(dd/mm/yr)

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The American Malaysian Chamber of Commerce (AMCHAM)

and the Malaysian-American Commission on Educational Exchange (MACEE)

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