Application Form -- Scholarships and Study Loans

Name of Programme: _____________________________________Intake: _____________________

1. Personal Information of Applicant

Name:_________________________________________	NRIC No._______________________________
Address:_________________________________________________________________________________
________________________________________________________________________________________
Tel: __________________________________________	Email:_________________________________
Sex: Male ( ) / Female ( )	Date of Birth ____________________________

2. Information of Applicant’s parents

Name of Father:_________________________________	NRIC No._______________________________
Date of Birth: ___________________________________	Place of Birth:____________________________
Address:_________________________________________________________________________________
________________________________________________________________________________________
Tel: (H)__________________(O)____________________________(HP)_____________________________
Fax:___________________________________________	Email:__________________________________
Occupation:_____________________________________	Yearly income: ___________________________
Name of Mother :________________________________	NRIC No._______________________________
Date of Birth:___________________________________	Place of Birth:____________________________
Address:_________________________________________________________________________________
_________________________________________________________________________________________
Tel: (H)__________________(O)___________________________(HP)______________________________
Fax:___________________________________________	Email:__________________________________
Occupation:_____________________________________	Yearly income: ___________________________

Note: Parents are required to submit: photocopies of identity card, Income Tax Form J, EA form.

3. Type of Scholarship and/or Study Loan Applied (Please tick one):

(Please refer to the Criteria and Types of Scholarships and Study Loans for more details)

q Scholarship [ ] Study Loan [ ]

Signature of Applicant

Date of Application

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