IJM Scholarship Awards 2008 Online Application

	Wisma IJM, Jalan Yong Shook Lin 46050 Petaling Jaya, Selangor Darul Ehsan Tel : 03-79858288 Fax : 03-79521200 Email: hr_scholarship@ijm.com http://www.ijm.com/

Application For IJM Scholarship Awards 2008

Updated : 19/03/2008

* Compulsary Fields

A. I AM APPLYING FOR ADMISSION TO: *

Choice 1 of Course/Discipline	*	University	*
			Note: If your choice is not listed in the list, select "Other" and type in your university's name

Choice 2 of Course/Discipline	*	University	*
			Note: If your choice is not listed in the list, select "Other" and type in your university's name

Choice 3 of Course/Discipline	*	University	*
			Note: If your choice is not listed in the list, select "Other" and type in your university's name

Year of Entry	*	Expected Graduation	*

B. PERSONAL DETAILS

Name as in the IC

Home Address

Postcode

State

City/Town

Telephone No. (Home)

* (e.g. 03-12345678)

Handphone No.

* (e.g. 012-1234567)

E-mail Address

* (e.g. abc@abc.com)

NRIC No.

* (e.g 841201-03-5525)

Gender

How many brothers and sisters do you have?

Brother(s) Sister(s)

What are their age range?

(e.g. 18 - 25)

Are there any other dependants living with your family?

Who are they?

(e.g. brother, grandmother etc)

Are you holding any scholarship or receiving financial assistance from any orginisation/institution?

If yes, what is the amount?

C. DETAILS OF YOUR SECONDARY SCHOOL STUDIES (Certified copies of results to be submitted once shortlisted)

SPM

Grade (e.g. 10A, 2B, 1C) Exam Year School

Subject	Grade	Subject	Grade

STPM/Matriculation

Exam Year Result (e.g. 2A, 1B, 1C) CGPA (e.g. 3.97) School/ Matriculation

Subject	Grade	Subject	Grade

D. EXTRA CO-CURRICULAR ACTIVITIES

List all extra co-curricular activities in which you have held positions of responsibility or in which you have excelled
in your Sixth Form. These must be substantiated in your leaving certificate or testimonial. Please list the highest position first.

Club/Society	Position of Responsibility

List all games/sports in which you have represented your state/school/house or held positions of responsibility.
These must be substantiated in your leaving certificate or testimonial. Please list the highest achievement first.

Games/Sports	State/School/House	Position of Responsibility

E. DETAILS OF PARENTS

01. Parents' Address (If it the same as your address, write 'As Above' below)

06. Mother's Name

07. Mother's Occupation

08. Name Of Your Mother's Business/Employer.

02. Father's Name

03. Father's Occupation

04. Name Of Your Father's Business/Employer.

Tel. No.

09. What Is Your Mother's Monthly Salary/Income
RM

Tel. No.

10. Other Monthly Income ( Including contribution from other family members)
RM

05. What Is Your Father's Monthly Salary/Income
RM

11. Total Monthly Income (total up questions 5, 9 and 10)
RM

F. FINANCIAL DETAILS

I. Resources/Assets

II. Commitments/Debts

01. Cash In the Bank
RM

Do You Or Your Parents Have Any Debts Or Other Financial Commitments To A Bank Or Any Other Institutions, Family Or Friends ?

02. Other Assets (Property, car, etc)

01. Commitments / Debts

List the Assets and Give Approximate Total Value

Person/Institution to Whom Commitment/ Debt is Owed	Nature of Commitment (eg. loan mortgage)	Amount

TOTAL ASSETS RM

02. What Is The Total Monthly Repayment Towards The Debt?

03. When shortlisted, a copy of recent Income Tax Return to be submitted.

TOTAL MONTHLY REPAYMENT RM

G. WHY I'M APPLYING *

Please write a short essay of approximately 400 words describing yourself.
Give reasons why you are applying for this scholarship and why you want to do the course for which you are applying.

words

H. DECLARATION

I certify that all the foregoing information is accurate. I understand that any willful withholding of information or false statement that I make in the application will render this application or subsequent offer of scholarship award and agreement by IJM null and void.

DATE: ,