Scholarship Information Form

Scholarship form

1STUDENT INFORMATION

2FATHER'S INFORMATION

3MOTHER'S INFORMATION

4SIBLINGS INFORMATION

5DETAILS OF COURSES OFFERED / CURRENT STUDY INFORMATION

6ACADEMIC HISTORY INFORMATION

7OTHER FINANCIAL ASSISTANCE INFORMATION

8REFERENCE

9APPEAL

10DOCUMENTS UPLOAD

11DECLARATIONS

Full Name *

Address *

Identity Card No *

Date of birth *//

Race *

Please Specify *

Religion *

Please Specify *

Phone Number *

Email *

Confirm Email

Gender *

Student Health *

Type of health issue *

Disabled person *

Type of disablility *

Ownership - Do you have? *

Motorcyle
Mobile Phone
Ipad/Tab
Car
Others

You can give more than one answer

Motorcycle Model *

Mobile Phone Model *

Ipad/Tab Model *

Car Model *

Specify others ownership *

Bank Account Number *

Bank Name *

Father's Name *

Address *

Identity Card No *

Date of birth *

Marital Status *

Single
Married
Divorce
Deceased

Date of Death *

Race *

Malay
Indian
Chinese
Others

Specify your race *

Religion *

Islam
Hindu
Christian
Other

Specify your religion *

Citizenship *

Malaysian
Others

Specify your citizenship *

Contact No *

Email *

Occupation

Government Servant
Private Sector
Not working
Retired with pension
Retired with no pension
Other

Specify your occupation *

Monthly Income (RM)

Mother's Name *

Address *

Identity Card No. *

Date of Birth

Marital status *

Single
Married
Divorced
Deceased

Date of death *

Race

Malay
Indian
Chinese
Others

Specify race *

Religion *

Islam
Hindu
Christian
Others

Specify Religion *

Citizenship *

Malaysian
Others

Specify citizenship *

Contact No *

Email *

Occupation *

Government Serant
Private Sector
Not Working
Retired with pension
Retired without pension
Others

Specify occupation *

Monthly income (RM) *

The form will auto add up until 5 siblings. Please upload an attachment in pdf or word document with required info if you have more than 5 siblings in upload page.

Sibling 1

Sibling 1 Name

Relationship

Marital Status

Single
Married
Divorced

Age

Occupation

Income (RM)

Sibling 2

Sibling 2 Name

Relationship

Marital Status

Single
Married
Divorced

Age

Occupation

Income (RM)

Sibling 3

Sibling 3 Name

Relationship

Marital Status

Single
Married
Divorced

Age

Occupation

Income (RM)

Sibling 4

Sibling 4 Name

Relationship

Marital Status

Single
Married
Divorced

Age

Occupation

Income (RM)

Sibling 5

Sibling 5 Name

Relationship

Marital Status

Single
Married
Divorced

Age

Occupation

Income (RM)

University / College / Skills Training Centre / Centre of Excellence *

Address *

Faculty *

Course / Program (Certificate / Diploma / Degree) *

Course / Program Name *

Study Status *

I have started my studies
I have not started my studies, but have been accepted

Admission Date *

Matric No

Current Semester

Academic year

Duration of study (Years)

GPA/CGPA

Tuition fees/semester (RM)

Tuition fees/year (RM)

Living Allowances (RM)

Estimated cost of living / current expenses (RM)

Lodging during study

Hostel
Family
Rental (House/Room)
Others

Specify others lodging

Academic History (Tick which applies) *

SPM / SPMV
STPM
Pre-Diploma / Pre-Science / Matriculation
Diploma

SPM/SPMV Year *

SPM/SPMV Result *

STPM Year *

STPM Result *

Pre-Diploma / Pre-Science / Matriculation Year *

Pre-Diploma / Pre-Science / Matriculation Result (CGPA) *

Diploma Year *

Diploma Result (CGPA) *

Do you receive more than one financial assistance? *

Institution / Company / Organization (name of the company providing the financial assistance) *

Address *

Amount of sponsorship / financial assistance / financial loan per semester (RM) *

Duration of sponsorship / financial assistance / financial loan (Years) *

1st Reefree

1st Refree Name *

Organization *

Occupation *

Contact No *

Email *

2nd Reefree

2nd Refree Name *

Organization *

Occupation *

Contact No *

Email *

PLEASE STATE A STRONG REASON WHY ARE YOU APPLYING FOR ETSB SPONSORSHIP PROGRAM *

ID Card *