CEL 2106 Portfolio 2 Merdeka Scholarships Application Form 2016

Merdeka Scholarships o f n o t

Closing Date : 2 m 201 o r e

Note:

1. Secti ons mark ed *** must be comp leted

t h a n

2. Pleas e use UPPE R CAS E LETT ERS unles s stated other wise

3. Pleas e attach the follo wing docu ments :

1 .

1 , 0 0 0 w o r d s t h a t i n c l u d e s :

A

-

s i g n e d p e r s o n a l s t a t e m e n t

A d e s c r i p t i o n o f t h e i n

t ford; e The personal qualities that make you n a worthy recipient of a d scholarship;| e d 2. A list of a academic r qualifications and e other awards and a honours received o 3. A copy of the f document showing s the status of your t application to the u University of d Oxford y 4. Two ; confidential letters of recommendation H from referees who o can assess the w applicant’s t academic h performance i s w i A. DEGREE APPLIED l l FOR *** b (Note: All applicants should apply to e the University of Oxford. This n Section refers to the candidate’s e separate application to the University f of Oxford) i t M Degree Masters DPhil a l a Course Name and Code y s Department i a Status of Application for Admission to the University of Oxford: ; a) Date of Application R e b) Status of Application Pending a s Offered a conditional offer o n Offered an unconditional offer s f o r w a B. PERSONAL n PARTICULARS *** t i (Note: All applicants should apply to n the University of Oxford. This Section refers to the candidate’s g separate application to the University t of Oxford) o s t Full Name u d IC No (New) y i n Place of Birth O x

Date of Birth Permanent address

Country (If outside Malaysia only)

1

Mailing address

Postcode Town State

Country (If outside Malaysia only)

Telephone

Mobile

Email

(Use uppe

Home Marital Status

Number of Childr

C. QUALIFICATIONS *** i - Professional qualification attained Professional body State

Country

Discipline Year (From) Parts Completed

Year (Completed) All

Part

Highest part completed

ii - Master’s Degree Institution / University State

Country

Discipline Year (From)

Year (Completed)

CGPA / Grade

ii - First Degree Institution / University State

Country

Discipline Year (From) CGPA / Grade

Year (Completed) Point / Class

2

ii - Diploma Institution / University State

Country

Discipline Year (From)

Year (Completed)

CGPA / Grade

D. VOLUNTARY ACTIVITIES (Attach a full description if necessary) i - Society / Club No

Society / Club

Position / Role Assumed

Year

Sports / Games

Represented

Year

1 2 3

ii - Sports / Games No 1 2 3

iii - Awards / Commendations (Name main awards) No

Awards / Commendations received

Level

Year

1 2 3

3

E. EMPLOYMENT (If Relevant) Please provide details of current / last employment, if any :

Are you currently employed ?

Yes

No

Current / Last Employer Address

Number of years with current/last employer Position in company Last drawn monthly salary

RM

F. REFEREES *** Please give details of the two referees who have written letters of recommendation on your behalf.

Referee 1 Name Address

Position Email address (Use upper or lower case as per actual address)

Referee 2 Name Address

Position Email address (Use upper or lower case as per actual address)

4

F. DECLARATION *** 1•

I consent to the collection, processing, sharing and use of relevant personal data by the Centre for the purposes of processing my application for study, for administration and (where applicable) for funding purposes, subject to the provisions of the Data Protection Act 1998.

2•

I understand that such personal data may be used and shared with third parties, some of which may be located overseas (including outside the European Economic Area), for the purposes of verifying my identity, qualifications, work experience, references and any submitted work. Where I apply for funding through the University, my personal data may be shared with third parties relevant to that funding application.

3•

I understand that the Centre will normally only discuss my application with me, unless I have nominated a third-party agent on my application form.

4•

I understand that if any information or statement provided on or to support this application form is not true, accurate, current and complete, or any supporting material is not entirely my own original work, except where clearly stated otherwise, the Centre may process and use this fact as relevant personal data. Such data may be used and shared with third parties, including Higher Education institutions, some of which may be located overseas (including outside the European Economic Area), to the extent necessary for the purpose of preventing fraudulent or dishonest applications for study, funding and/or visas.

5•

I understand that if I become a registered student, any personal data collected by the Centre as a result of my application will form part of my student record.

Name Date

5