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JCF-Monash-Equity-Scholarship-Application-Form

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JCF-Monash Equity Scholarships Application Form
SECTION 1: APPLICANT DETAILS
Name (as in IC)
IC no.
Permanent Home Address
Mailing Address
E-mail address
Home Telephone
Mobile Telephone
SECTION 2: COURSE DETAILS
School
Course applied
Intake
SECTION 3: ACADEMIC QUALIFICATIONS
STPM / A-LEVEL /
Equivalent
Date completed
SECTION 4: FAMILY DETAILS
Father’s (or
Guardian’s) name
Occupation *
Age
Income per month (RM)
Mother’s (or
Guardian’s name
Occupation*
Age
Income per month (RM)
* If your parents / guardians are self-employed, please indicate so. For retirees, the last drawn pay slip/ income
tax statement must be enclosed.
Sibling Details
Name
Age
Occupation / Student
Source of financial
support
Other Dependents
Name
Age
Occupation / Student
Source of financial
support
SECTION 5: EXTRA-CURRICULAR ACTIVITIES AND COMMUNITY ENGAGEMENT
SECTION 6: DOCUMENTS CHECKLIST
o Copy of Identity Card
o Certified True Copies of official academic records
o Copy of other relevant documents eg: Latest pay-slip/ Income Tax Form, Certificates for extracurricular activities etc.
SECTION 7: PRIVACY STATEMENT AND DECLARATION
Privacy Statement
The protection of personal data is important to Monash University Malaysia. Any personal data collected on this
form will be treated in accordance with the Personal Data Protection Notice of Monash University Malaysia
accessible via http://www.monash.edu.my/.
Declaration
I have read the Personal Data Protection Notice provided by Monash University Malaysia pursuant to Section 7 of
the Personal Data Protection Act 2010 accessible via http://www.monash.edu.my/, which includes the purposes for
which my personal data is collected/processed and classes of third parties to whom Monash University Malaysia may
disclose my personal data.
I hereby give consent to Monash University Malaysia to process my personal data in accordance with the Personal
Data Protection Notice.
I declare that the information given by me in this form is correct to the best of my knowledge. I agree to abide by
the conditions of the award as well as course regulations and rules, where applicable.
Signature of applicant:
Date:
Name:
Please return the completed application form and scanned copies of all relevant supporting documents via email to
[email protected]
Telephone: +603-5514 5602 / +603 5514 4428
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