GAMUDA GROUP OF COMPANIES

( 29579 - T)

SCHOLARSHIP APPLICATION FORM

l For Bachelors Degree Only l All questions and essay in this application must be completed l Where inapplicable, put NIL / NA

Course of Bachelors Degree Applied For / Currently Pursuing How did you know about our scholarship advertisement?
The STAR Harian Metro Gamuda's Website Facebook

AFFIX RECENT PHOTOGRAPH

Those who applied previously need not write in again

Others please specify :

A. PERSONAL DETAILS
Full Name:
(as appears in NRIC / Passport)

Other Name (if any): Date of Birth: Race: Permanent Address: Age:

NRIC No: Gender: Marital Status: Mailing Address (if different from Permanent Address):

House Telephone No:

Handphone No: Period From (mth&yr) To (mth&yr)

E-mail address: Course of Study Certificate / Diploma Obtained

B. EDUCATION (in chronological order)

Secondary School / College / University Attended

C. ACADEMIC QUALIFICATIONS (Please enclose certified copies of your results, certificates & testimonials)
SPM DETAILED RESULTS *STPM / A-LEVEL / MATRICULATION / DIPLOMA / FOUNDATION STUDY DETAILED RESULTS

Year :

Year :

Subject

Grade

Subject

Grade / CGPA

Aggregate (if applicable) : * Please circle the relevant exam

2013 Application Form Page : 1

D. COURSE OF STUDY & UNIVERSITY

(a) I am applying for admission to: (Please list in order of preference) Name of University / College and location Course Applied Course Duration (Years)

(b) If you are currently in University / College, please provide the following details and attach your Letter of Offer: Period Name of University / College Course of study Expected to Joined (mth&yr) complete

Course Duration (Years)

Note: Please include detailed results slip for every semester

E. SCHOLARSHIP & LOAN

Have you been offered any scholarship award / bursary / study loan to any University / College? (If yes, please specify) Amount Received Name of Sponsor(s) University / College Faculty / Course To Date Bond period (if any)

If not, have you applied for any scholarship award / study loans? Name of Sponsor(s) Faculty / Course

Coverage Amount

Bond period (if any)

F. EXTRA-MURAL ACTIVITIES
(i)

- FORM 4 ONWARDS (To enclose certified copies of certificates) School Responsibilities (e.g. prefect, monitor) Year Name of School / College / University Post Held From To

Type of Responsibility

(ii)

Club / Society (excluding sports activities) Name of School / College / University Year From To Name of Club/Society/ Uniformed Body Post Held
(e.g. President/Secretary/Treasurer/AJK)

(iii)

Sports Year Name of School / College / University From To Sports Activities

(e.g. Badminton,Football, Athletics, Club Activities)

Representing Level (Please circle) Post Held

Level (National, State, District,College, School)

N N N N N (iv) Others (debate, camps, essay writing competition, quiz, chess, arts, drawing etc.) Year Name of School / College / University Type of Competition From To

St St St St St

D D D D D

C C C C C

Sc Sc Sc Sc Sc

Representing Level (Please circle)

Level (National, State, District,College, School)

N N N N N
2013 Application Form

St St St St St

D D D D D
Page : 2

C C C C C

Sc Sc Sc Sc Sc

G. WORK EXPERIENCE (including Industrial Attachment)

Name of Company Period From (mth&yr) To (mth&yr) Salary Designation Experience / Knowledge gained

H. FAMILY BACKGROUND
(a) Name of Father: Occupation:

(Please enclose a photocopy of the latest EA form / Salary slips / Pension card) Age: Handphone No:

Company's name (if retired, state former company): Company's Address: Salary / Income / Pension per month RM: Office Tel No: (b) Name of Mother: Occupation: Company's name (if retired, state former company): Company's Address: (c) Brothers & Sisters (Including those already married) Name Relationship Married/ Single Salary / Income / Pension per month RM: Office Tel No: Age Occupation. If studying state School / University Salary / Income per month (RM) Age: Handphone No:

(d) Total family income per month How much financial assistance can your family offer you per month for studies and living expenses? (e) Property (e.g. land, house, shoplot, etc.) Type Estimated Value (RM)

RM RM

(f) Other income (e.g. rent, funds, etc.) Type Estimated Value (RM)

(g) Commitments / Debts Do you or your parents have any debts or other financial commitments to a bank or any other institutions? If yes, please specify: Name of Bank / Institution Nature of Commitment (e.g. loan, mortgage, etc.) Amount (RM)

2013 Application Form

Page : 3

NAME :

DATE : ________________

I. ESSAY CONTRIBUTION (To attach extra sheet if necessary)

Please describe your career aspiration and personal attributes that would help you in achieving your ambitions. Please write in approximately 300 words.

2013 Application Form

Page : 4

J. OTHER MATTERS
Hobbies:

Ambition: Language & Dialects: List your language & dialect ability and tick the relevant boxes spoken spoken spoken written written written Yes / No spoken spoken spoken written written written

Do you have any relatives or friends working in this Company or its subsidiaries? If yes, Name : Relationship :

Have you ever been convicted of any criminal offence ? Yes / No Do you suffer from any physical handicap / illness ? Yes / No Have you joined National Service? Yes / No

If yes, please state If yes, please state If yes, please state year

I declare that the information given above is correct, complete and true. I understand that any false information or documents given may render me liable to disqualification even if accepted. Willful suppression of any material will similarly be penalised.

Signature of Applicant IMPORTANT NOTES :

1 2 3

Date

Applicants are reminded NOT to send original certificates and testimonials when submitting application form. The completed application must reach us not later than 10 May 2013 either by hand or mail. We would not be responsible for any loss in delivery or mail. Incomplete application will not be considered. Write "Scholarship Award " and indicate the course applied for on the top left hand corner of the envelope.

4 5

Your checklist: Please indicate attachments (It is compulsory to show proof of financial needs)
Certified Results
(SPM, STPM / equivalent)

Certified Certificates
(Form 4 & above only)

Certified Testimonial

Photograph

Certified Extra-Mural Activities Certificate

(Form 4 & above only)

EA Form / Salary slip Pension Card

Written Essay

OTHERS

2013 Application Form

Page : 5