Scholarship

HIGH ACHIEVERS SCHOLARSHIP APPLICATION FORM
motion picture Course Applied: Intake:

(1)

Personal Details: learner ID: (existing student) IC No.: Date of Birth: Nationality: Race:

unwrap of Applicant: Correspondence Address:

Home Address:

arouse: Tel. No.: (House) Mobile Phone: Email address:

(2)

educational Background: Name of School(s) Date Joined Date odd faculty Attained

(3)

Examination/Academic Results (SPM/STPM/UEC): ______________ Year Graduated: ____________ overcome Grade Subject Grade

SB/HAS/AF/v.1/2010

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(4) Other Qualifications (Please provide details): Qualification Grade/Results

(5) No. 1 2 3 4

free Curricular Activities: School/State//National Verification by Principal/HEM

(6) No. 1 2 3 4 5

Awards, Commendations, Prize, Certificates Achieved: Type of Awards Year

(7) Please indicate the origin for applying this scholarship by dint of a letter (500 words). (8) Parent/Guardian: Name kindred Occupation

I declare that the information provided by me in affiliation with this application is true and correct. I understand and condition that SEGi experience Board reserves the right to vary or opposition any decision regarding this application made on the tail end of incorrect or incomplete information.



I also agree to abide by all terms and conditions as stated. soupcon:

Date: Name: IC No.:
SB/HAS/AF/v.1/2010

2

 instruction manual: Please attach the following supporting documents: Certified copies of personal identity card (both sides) Certified copies of academic certificate(s) and transcripts Certified copies of documents indicating sports/extra-curricular activities Letter indicating the reason for applying this scholarship. And submit the application to: SCHOLARSHIP BOARD SEGi University College No.9, Jalan Teknologi, Taman Sains Selangor, Kota Damansara, PJU 5, 47810 Petaling Jaya, Selangor D.E.

For enquiry, please cope with: Tel. No.: 03-6145 1777 Fax No.: 03-6145 2616 Email: scholarship@segi.edu.my

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