CHAN KOK VENG & GOH JOO YI SCHOLARSHIP

Background

The contributors are a couple of hardworking Malaysians who would like to give back to the

Malaysian society by assisting the needy in pursuing their higher education.

Programmes of Studies

Foundation in Science (Year 1 Semester 1)

Foundation in Engineering (Year 1 Semester 1)

Foundation in Computing (Year 1 Semester 1)

Eligibility Criteria

Citizen of Malaysia

Obtained minimum 5As and C in all other subjects in SPM or equivalent

Financially needy with total monthly income of parents / guardian of RM5000 and below

Value of Scholarship

University fees as per student bill.

The tenure of the scholarship is only for the normal duration to complete the Foundation

programme.

Terms & Conditions

During the programme of study, the scholarship recipient is not allowed to hold concurrently

any other forms of financial assistance without prior written consent of the Scholarship

Administrators.

The scholarship is renewable every semester at the absolute discretion of the Scholarship

Administrators and subject to satisfactory academic performance and conduct.

The scholarship recipient is required to maintain a CGPA of 2.7500 every semester.

The award will be disbursed through the Bursary of TAR UC.

*Other terms and conditions apply.

Application

Application form can be downloaded from TAR UC website from 7 Oct 2019 (Monday) to

18 Oct 2019 (Friday).

Completed application form with relevant documents must be submitted to the Centre for Pre-

University Studies on or before 18 October 2019 (Friday).

Only shortlisted applicants will be required to attend an interview. Only successful applicant

will be notified.

For any enquiry regarding to application procedures and progress on the scholarship

application, please contact Centre for Pre-University Studies.

CHAN KOK VENG & GOH JOO YI SCHOLARSHIPAPPLICATION FORM

INSTRUCTIONS

a) Strictly for Malaysian only c) Attach a copy of the required documents

b) Please use BLOCK LETTERS only d) Incomplete applications will automatically be disqualified

Full Name: NRIC No:(As per NRIC)

Home Address: Postal Address:

Home Tel No: Handphone No:

Date of Birth: Age: Gender:

Email: Nationality:

Programme of Study:_________________________________________________________________________ Student ID No:________________________

SPM / O Level Detailed ResultsMain Subject

1

2

3

4

5

6

7

8

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10

11

12

13

A. *Please list the TOP 3 co-curricular activities you have joined in chronological order

PART IV - EXTRA CURRICULAR ACTIVITIES / SPORT / COMMUNITY SERVICE

PART I - PERSONAL DETAILS (STUDENT)

PART II - PROGRAMME OF STUDY

PART III - EDUCATION

Grade/CGPAYearSchool

Year Position Held Club / Society / Sport

Please tick on the

examination taken:

□ SPM

□ Cambridge O Level

Examination

Year Name of Award Award

B. * TOP 3 prizes / awards won such as academic / subject prizes, medals for sports / other competitions in school.

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Marital Status

Full Name

NRIC No.

Home Address

Telephone No- (Home)

(Handphone)

Age

Date of Birth

Nationality

Occupation (If retired, state the

previous occupation)

Name and address of employer /

own business. If retired, state name

and address of previous employer.

Office Telephone No.

Gross Salary / Monthly Income (RM)

Other Income (Please specify: i.e. rental,

contribution from working children,

SOSCO, odd jobs, etc.)

Duration

Other Scholarships / Loans that You are Currently Holding / Applying

Status (approved / pending approval)

Amount (RM)OrganizationScholarship / Loan

PART V - FAMILY DETAILS

Relationship

Occupation (if studying,

state level of studies &

name of

school/university)

Gross Monthly Income (If

studying, specify financial

aid received)

Contact No.

B. Particulars of all brothers & sisters

Name AgeGender

M/F

Marital

Status

Tick the following box if applicable:

□ Deceased □ Disabled

A.

PART VI - FINANCIAL AID

Father / Guardian Mother

Tick a box below:

□ Single □ Married

□ Divorced/Separated □ Widowed

Tick a box below:

□ Single □ Married

□ Divorced/Separated □ Widowed

Tick the following box if applicable:

□ Deceased □ Disabled

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Full Name

Postal Address

Telephone No.

OccupationEmail Address

Office - Tel. No.

Please tick (√ )either "YES" or "NO". If "NO" please explain under "Remarks"

Have you enclosed the following documents?

A. Documents related to Applicant:-1) TAR UC offer letter

2) Identity card and birth certificate

3) Passport-sized photograph

4) SPM/ 'O' Level results

5) Testimonials (if any)

6) Certificates for top extra co-curricular activities / prizes won

B. Documents related to Applicant's Parents / Guardians7) Parents' /Guardian's identity cards

8) Parents' / Guardian's proof of income*

C. Documents related to Applicant's Brothers / Sisters9) Birth certificates of all brothers and sisters

10) Brothers' and sisters' proof of income* ( if they are working)

11) Letters or documents to prove that brothers and sisters are pursuing

higher education in universities / colleges / institutions

RemarksIf "NO", please explain here.

PART VII - REFEREES

Names of two referees to whom reference may be made. Referees named should have known the applicant and the applicant's family

for a period of not less than 2 years. Referees can be relatives or close family friends. Referees should NOT be your own parents,

brothers / sisters or fellow students. Referees should be contactable by telephone during office hours.

Referee 1 Referee 2

PART VIII- DOCUMENTS CHECKLIST

YES NO

* Salary slips (past 2 months) / Income Tax Form B or BE together with EA forms (past 2 years) / EPF statement (past 2 years) / any others documentary proof.

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Write an essay in not more than 300 words on the following:

Date: __________________________________ Signature of Applicant: ___________________________________

Name: _____________________________________________________

1. Why do you need a scholarship?

2. How will the Chan Kok Veng & Goh Joo Yi Scholarship Awards assist you in achieving your ambition?

3. What will you do if you are not offered this scholarship?

* if there is insufficient space in the form, please attach additional sheets of paper.

PART IX - ESSAY

I certify that the information I have given in this application is complete and correct. I understand that any false declaration in my application will be grounds for immediate termination of this Scholarship.

I expressly consent and authorize the TAR UC to release my personal, academic and related records to my parents, guardians and/or any financial aid providers to which I have applied to for any reasons whatsoever.

PART X - DECLARATION BY APPLICANT

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Information For Making Applications For Scholarship Award Please read & understand the following instructions before filling up the application form.

I. Application Form(a) The student should complete ONE (1) copy of application form, and enclose a copy of the

following documents:

A. Documents related to Applicant:-1) TAR UC offer letter2) Identity card and birth certificate3) Passport-sized photograph4) SPM/ 'O' Level results 5) Testimonials (if any)6) Certificates for top extra co-curricular activities / prizes wonB. Documents related to Applicant's Parents / Guardians7) Parents' /Guardian's identity cards8) Parents' / Guardian's proof of income* C. Documents related to Applicant's Brothers / Sisters9) Birth certificates of all brothers and sisters

10) Brothers' and sisters' proof of income* (if they are working)11) Letters or documents to prove that brothers and sisters are pursuing

higher education in universities / colleges / institutions

(b) Please ensure that all documents and information requested are enclosed or stated.

II. Referees(a) Referees should be Malaysian citizens not related to the applicant but are able to provide information on the applicant. Names of referees who are fellow students or students from other institutions will not be accepted.

(b) One should be an academic referee who is able to comment on the applicant’s academic abilities while the other should be able to comment on the applicant’s financial circumstances.

III. Submission of ApplicationsCompleted application form and all supporting documents must be submitted to Centre for Pre-UniversityStudies, latest by 18 Oct 2019 (Friday). Incomplete applications will be disqualified.

Only shorlisted applicants will be required to attend an interview. Only successful applicant will be notified.

KOLEJ UNIVERSITI TUNKU ABDUL RAHMAN

CHAN KOK VENG & GOH JOO YI SCHOLARSHIP AWARD

* Salary slips (past 2 months) / Income Tax Form B or BE together with EA forms (past 2 years) / EPF statement (past 2

years) / any others documentary proof.

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