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Application for Scholarship Scholarships Available as below: (Please tick by category)  PRO VICE CHANCELLOR’S SCHOLAR (PVC)  DEAN’S SCHOLAR  Malaysian Only  Non-Malaysian Only (International Students)  Full time enrolled student in Degree  Full time enrolled student in Degree programmes at Curtin Malaysia programmes at Curtin Malaysia  (a) CM Foundation moving to degree with  (a) CM Foundation moving to degree with minimum Foundation CWA 80% minimum Foundation CWA 80%  (b) Current CM degree students (Second Year  (b) Current CM degree students (Second Year onwards) with latest CWA 80% onwards) with latest CWA 80%  Two scholarships at 100% each for  Two scholarships at 50% each for entire duration of Degree programme entire duration of Degree (3 to 4 years dependent on programme (3 to 4 years dependent programme enrolled) on programme enrolled) th th Closing Date : 17 February Closing Date : 17 February  CM SCHOLAR (DEGREE)  Malaysian Only  Full time enrolled student in Degree programmes at Curtin Malaysia  (a) CM Foundation moving to degree with minimum Foundation CWA 80%  (b) Current CM degree students (Second Year onwards) with latest CWA 80%  Full-Time enrolled student in Degree programme at CM 100% scholarship 50% scholarship Covers 1 year (2 25% scholarship semesters) of study  Closing Date: th Semester 1 : 17 February th Semester 2 : 5 August HOW TO COMPLETE THIS APPLICATION FORM:

1. 2.

Please complete using BLOCK LETTERS. All sections must be completed. IMPORTANT NOTES:

1. Application MUST reach Loans & Scholarships Office, Student Services Department by the date stated for each scholarship. Applications received after this date WILL NOT be entertained.

2. Please attach all certified true copies of examination certificates; testimonials; evidence of extra- curricular activities and other requirement as stated in the application form.

3. Incomplete applications will automatically disqualify. 4. Applications must be submitted in person or courier it to the Loans & Scholarships Office, Student Services Department. No scan copy or application by e-mail will be accepted.

5. Applicants must be an enrolled student at Curtin University, Sarawak, Malaysia. 6. Applicants must not currently hold any scholarship or loan. Mail this form to:

Loan & Scholarship Office – Student Services Department Curtin University, Malaysia, CDT 250, 98009 Miri, Sarawak, MALAYSIA. Tel: (+60) 085 443 939 ext. 3035 / 3925 Fax:(+60) 085-443 899 Email: [email protected]

Contact person:

Mr. Jeremy Edison George / Ms. Dahlia

CM Scholarship Application/Rev.2017

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PERSONAL DETAILS

Surname Given Names Title (Mr, Ms, etc) IC No. (Malaysians)

Sex -

Female

Male

Birth Date

D

D

M M Y

-

Place of birth

Student ID Number

Race/Ethnicity

Religion

PRESENT CONTACT ADDRESS –Your Preferred Mailing Address Number and Street Suburb / Town / City

Postal Code

Country

State Home Phone

Hand Phone

Office Phone

Email Address

PERMANENT HOME ADDRESS Is your permanent home address the same as your present contact address? YES

NO

If “No” Please complete the details below. Number and Street Suburb / Town / City

Postal Code

Country

2.

State Home Phone

PROGRAMME DETAILS

Course Enrolled

Current Year of Studies:

CM Scholarship Application/Rev.2017

Current Semester:

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Y

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EDUCATION – Provide details of your SPM/O’Levels/Foundation/Matriculation/STPM/A-Levels/UEC or equivalent

3.

SPM/O’ Level/ Foundation/ Matriculation or equivalent

STPM/UEC/A’ Level or equivalent

School/College:

School/College:

Year

Year

Subjects

4.

Grades

Subjects

Grades

CURRENT SCHOLARSHIPS OR LOANS

Are you currently holding or applying any other scholarships or loans? NO. I hereby confirmed that I am not holding /Applying any scholarship or loan from any organizations/providers.

YES. If YES, give details: ______________________________________________________________________________________________

CM Scholarship Application/Rev.2017

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KINDLY LIST YOUR EXTRA CURRICULAR ACTIVITIES WHILE IN SCHOOL/OR WITH THE WIDER COMMUNITY __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

6.

KINDLY LIST THE AWARDS YOU HAVE RECEIVED WHILE AT SCHOOL/OR FROM THE WIDER COMMUNITY __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

CM Scholarship Application/Rev.2017

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PERSONAL STATEMENT (In not more than 200 words, write an essay on the following topic: “Having a Curtin Malaysia Scholarship Award will enable me to reach my career goals”.

__________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

8.

DECLARATION & SIGNATURE (S)

I declare that all the information provided by me for this application is true. I acknowledge that Curtin Malaysia reserves the right to vary or reverse any decision regarding this scholarship offered on the basis of incorrect or incomplete information provided by myself.

Signature of applicant

: ______________________

Date:

___________________ (DD/MM/YYYY)

Signature of Parent/ Guardian : ______________________ (If applicant is below 16 years of age)

IMPORTANT CHECKLIST BEFORE SUBMITTING YOUR APPLICATION. Completed Application form with signature Certified true copy of Applicant’s IC/Passport Certified true copy of Offer Letter to CM Certified true copy examination result (CM Foundation overall results (completed 2 Semesters)/SPM/ STPM/UEC/A’ Level (ACTUAL RESULTS) Certified true copies of evidence of extracurricular activities

FOR OFFICE USE ONLY

Date Received:

CM Scholarship Application/Rev.2017

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