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HELP UNIVERSITY COLLEGE

The Principal’s List Award (PLA)


Scholarship Application Form
BZ-2 Pusat Bandar Damansara, 50490 Kuala Lumpur, Malaysia.
Tel: 603-20942000 Fax: 603-20947495 http//:www.help.edu.my

PHOTO
A. PERSONAL PARTICULARS (Please use BLOCK LETTERS)

FULL NAME

E-MAIL
ADDRESS
PERMANENT
ADDRESS

PERMANENT HANDPHONE NO.


TEL NO.

CURRENT
ADDRESS
(If different
from above)
CURRENT NRIC NO.
TEL NO.

SEX M F MARITAL STATUS

DATE OF BIRTH AGE

NATIONALITY RACE

B. PROGRAMME APPLIED FOR Intake: Month: Year:


(Please refer to Course Listing as attached)

___________________________________________________________________________________________

C. CATEGORY APPLIED FOR (Please tick one)

Academic Merit Award ECA Award

Scholarship (Full) Bursary (Partial)

Bursary (Partial)

the university of achievers

Note: Late and incomplete application forms will not be considered for selection
D. ARE YOU CURRENTLY HOLDING ANY OTHER SCHOLARSHIP / FINANCIAL ASSISTANCE?

No Yes State the name of the organisation awarding the scholarship or financial assistance

______________________________________________________________________

E. DETAILS OF PARENTS, GUARDIAN OR NEXT OF KIN

FATHER'S NAME MOTHER'S NAME

NRIC NO. NRIC NO.

OCCUPATION OCCUPATION

OFFICE NAME & ADDRESS OFFICE NAME & ADDRESS

OFFICE TEL.NO. OFFICE TEL.NO.

MOBILE PHONE NO. MOBILE PHONE NO.

Are your parents financing your studies? Yes No


If not, please specify name of the person who is financing your studies (FINANCIAL SPONSOR)

NAME: _____________________________________ NRIC NO:___________________________________________

RELATIONSHIP:______________________________ OCCUPATION:_______________________________________

F. DETAILS OF OTHER FAMILY MEMBERS (grandfather, sisters, etc) SUPPORTED BY PARENTS/


FINANCIAL SPONSOR

NAME 1 OCCUPATION/SCHOOL 1

RELATIONSHIP 1 AGE 1

NAME 2 OCCUPATION /SCHOOL2

RELATIONSHIP 2 AGE 2

NAME 3 OCCUPATION /SCHOOL3

RELATIONSHIP 3 AGE 3

NAME 4 OCCUPATION /SCHOOL4

RELATIONSHIP 4 AGE 4

Note: Late and incomplete application forms will not be considered for selection
G. ACADEMIC RECORDS

HIGHEST TERM EXAMINATION PASSED: SPM/ 'O' Levels STPM/ 'A' Levels Others___________

SPM/ 'O' LEVELS OR EQUIVALENT: SCHOOL/ INSTITUTION__________________________________YEAR _________

NO SUBJECT GRADE NO SUBJECT GRADE

1 6

2 7

3 8

4 9

5 10

STPM/ 'A' LEVELS OR EQUIVALENT: SCHOOL/ INSTITUTION__________________________________YEAR ________

NO SUBJECT GRADE NO SUBJECT GRADE

1 6

2 7

3 8

4 9

5 10

OTHERS__________________SCHOOL/ INSTITUTION________________________________________YEAR _________

NO SUBJECT/ UNIT NAME GRADE


GRADE
SU
BJ
EC
T/
UNI
T
NA
ME

GR
AD
E

Note: Late and incomplete application forms will not be considered for selection
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NOTE:

Please
Please attach
attach CERTIFIED
CERTIFIED TRUE
TRUE COPY of atCOPIES of results/
least the LAST transcripts
TWO LEVELS with this
of statement application form.
of results/transcripts with this application form.

ENGLISH TEST SCORE TOEFL GCE 1119 IELTS

H. EXTRA-CURRICULAR ACTIVITIES
(Complete this section in detail. You may attach a separate sheet, if required)

NO GAMES/SOCIETIES POSITION HELD YEAR

10

NOTE:

Please attach CERTIFIED TRUE COPIES of certificates of ECA achievements with this application

I. PERSONAL MOTIVATION / OBJECTIVES (State briefly your career aspirations. You may attach a separate
sheet, if required)

Note: Late and incomplete application forms will not be considered for selection
J. RECOMMENDATION OF SCHOOL PRINCIPAL

I recommend that (name of student ) is awarded the

ACADEMIC MERIT AWARD (SCHOLARSHIP; FULL) / ACADEMIC MERIT (BURSARY; PARTIAL) / ECA

AWARD (PARTIAL)* from HELP University College under the Principal’s List Awards. (* delete where appropriate)

School Principal’s Name:

Signature :

Date :

School Stamp :

K. TERMS AND CONDITIONS OF THE AWARDS

1. Attach all documentary evidence of academic and other qualifications with this form.
2. HELP University College reserves the right to revoke any scholarship due to failure in examinations, withdrawal
from program before completion and/or non-compliance with the Rules and Regulations of the HELP University
College.
3. All decisions made by HELP University College on matters pertaining to the scholarships will be final.
4. Short-listed applicants will be notify
5. The scholarship is awarded based on recommendation of the School Principal. Hence, the School Principal
must endorse the Scholarship Application Form and clearly indicate the type of award.
6. Application form should be submitted to HELP University College through the school. Individual submission by
applicants will not be accepted.
7. Application forms should reach HELP University College by 10 December 2006 for year 2007 intakes.
8. The short-listed applicants are required to confirm acceptance of the scholarship by registering with HELP
University College by 30 December 2006. Application and Registration Fees must be paid by this date. Failure to
do will imply that the applicant declines the scholarship.

Note: Late and incomplete application forms will not be considered for selection
9. In order to cultivate leadership and organizational capabilities. PLA scholarship recipients are required to fulfil an
internship of 3-5 hours per week to assist the Academic Department in administration, peer counselling, extra
curricular activities, and marketing activities.

L. DECLARATION

I, the undersigned, declare that the particulars given by me in this form are correct, that I have read the terms
and conditions of the scholarship and agree to abide by the terms and conditions of the scholarship. I
understand that the award can be withdrawn if any information given in this form is found to be inaccurate. I
have read and understood the conditions of the award as stated in the form.

Applicant's Signature Date

for office use only

DATE FORM RECEIVED ____________________________________________

Recommended by:______________________ Date:_____________________

Recommendation:____________________________________________________________________________________________

Scholarship Committee Meeting Date Approved / Rejected

Registrar’s Signature _______________________________

Note: Late and incomplete application forms will not be considered for selection