Scholarship Application Form

Name of Graduate School, Course Applied For & Course Date:

Present Postal address:

Full Name (block letters):

Postcode: Phone No.: Email:

Sex: Age: Date of Birth: NRIC:

Postcode: Phone No.: Email:

Home address (if different):

Postcode: Phone No.: Email:

Next of Kin:

What other scholarships, fellowships or awards are you applying for?

Have you applied for a Tun Suffian Scholarship before?

Prizes and Distinctions obtained

Tun Suffian Foundation Scholarship Application Page 1 of 2

Higher Education University/College Course of Study

Results(If not a graduate, state subjects of degree

examination and dateit will be taken)

Glue or staple here

photograph taken

within the last year

(the same portrait

each copy)

applicable for malaysian only

/ /mm - -yyyy

Tun Suffian Foundation Scholarship Application Page 2 of 2

Name Position Address

Employment History If Applicable:

Company & Address Position Held Year (From - To)

DECLARATION

I declare that the statements in my application for a Tun Suffian Scholarship are true and that having read the Prospectus of the Scholarships,

I will, if successful, abide by the rules which it contains.

Date................................... Signature .................................................................................................................

Applications are to be submitted to the DEANS of the respective universities, who shall thereafter forward to the Honorary Secretary of the

Foundation at Suite 2-4, Level 2, Tower Block, Menara Milenium, Jalan Damanlela, Pusat Bandar Damansara, 50490 Kuala Lumpur,

Malaysia.

* With each copy of this application form, please enclose a short account (which MUST NOT exceed 500

words) which you have composed and signed, describing your academic pursuits, general activities,

intellectual interests, plans for the future, and reasons for wishing to to pursue the course.

Names and addresses of two referees. At least one should be someone from your university or university college who has supervised

your studies. The reference should be forwarded by the Head of your college or the Vice-Chancellor of your university, Other references

can be sent directly to the Honorary Secretary of the Foundation at Suite 2-4, Level 2, Tower Block, Menara Milenium, Jalan Damanlela,

Pusat Bandar Damansara, 50490 Kuala Lumpur, Malaysia, to arrive Before closing Date

If you have worked on a research project, either for your first degree or subsequently, please describe your work below; your account

should be intelligible to anyone who is not a specialist in your field. If you have no such research experience, leave this blank; a blank

entry will not prejudice your application.