Professional Documents
Culture Documents
(Important Note: Please read the instruction on page 4 prior to completing this form)
IC / Pasport Number:
Sex: (M/F)
Nationality:
Marital Status:
Date of Birth:
Race:
Age:
Religion:
Correspondence Address:
Poscode :
State :
Tel Number :
Poscode :
State :
Tel Number :
Guardian's Occupation:
Guardian's Address:
Poscode :
State :
Tel Number :
Duration (semesters):
Schools / Institutions
Year
City / State
PMR
SPM / SPVM / O Level
STPM / A Level / Matriculation
Others (Please specify) :
Agency
Year
Duration
Details
Full Name
IC No.
Permanent Address
Correspondent Address
Father
Mother
Section 6: SIBLINGS
No.
Name
Age
Occupation / School
1
2
3
4
5
6
7
8
9
10
DECLARATION BY APPLICANT
I declare that the information provided in connection with this application is true and correct. I understand that
MSU reserves the right to vary or reverse any decision regarding this scholarship on the basis of
incomplete information.
Applicant's signature
Date: _______________________________
Remark:
successfull
unsuccessfull
All applicants must write their full name exactly as per identity card or 'Resit Pengenalan Sementara' (JPN 1/9) or
or 'Resit Penukaran Kad Pengenalan' (JPN 1/22) issued under the National Registration Act (1959) where applicable.
A legible photocopy of the idendity card or 'Resit Pengenalan Sementara' or ' Resit Penukaran Kad Pengenalan'
must be enclosed togetherwith Application Form.
Form defaced by erasure or any kind of correcting fluids may results in the application being not be accepted at the
descretion of MSU. Every amendment must be clear and legible and should be countersigned in full by applicant.
Each completed application form must be accompanied by certified and clear copies of relevant documents
eg) certified transcripts, parents' payslip (or declaration of income)
MSU reserves the right to require any applicant to appear in person before MSU management to ascertain
the genuineness of the information provided by the application form submitted.
MSU shall not be liable to return the submitted application form or any document/s and/or transcripts attached.
Applicants should not send original copies of the documents.
MSU reserves the right to reject/withdraw any application which do not confirm to the above
instructions or which are illegible or which are accompanied by remittance/s improperly drawn.
The Secretariat,
Scholarship Unit - Yayasan MSU,
University Drive,
Off Persiaran Olahraga,
Seksyen 13,
40100 Shah Alam.
(attn: Dato' Sharifah Huda Engku Muda)