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PROJECT ILHAM : INSPIRING EXCELLENCE
Page 1 of 2 (PTO)
STUDENT APPLICATION FORM 2014
1. Applicant must be a Malaysian citizen and obtained 7A’s in 2013 UPSR examination.
2. The following items/documents must be attached and stapled with the application form:-
a. a copy of 2013 UPSR examination results; b. a copy of parent(s)’/guardian’s latest payslip/certified income
statement; c. copies of extra co-curricular activities certificates; and d. passport-sized photo pasted on the form at given space.
3. Please print the 2 page application form in 1 sheet of paper (both sided). 4. Applicant MUST attend the written test to be conducted at selected centres. Change of centres allowed if there are valid reasons. 5. Project Ilham Steering Committee reserves the right to approve/reject any application based on selection criteria and availability. Decisions are final and confidential.
1. FULL NAME (AS PER NRIC)
2. FULL ADDRESS
3. E-MAIL
4. GENDER: MALE FEMALE 5. DATE OF BIRTH (DD/MM/YYYY) : _____ / _____ / __________
6. IDENTIFICATION CARD NO. : _________________- _____ - ___________
7. FATHERS’S/GUARDIAN’S NAME
8. FATHER’S / GUARDIAN’S OCCUPATION
9. CONTACT NUMBER
Please paste a
current passport-
sized photos of
the applicant.
Page 2 of 2
PI-01 V 3.0
10. MOTHER’S NAME
11. MOTHER’S OCCUPATION
12. EMERGENCY CONTACT TEL. NO.
13. EMERGENCY CONTACT PERSON
14. APPLICANT IS CHILD NO ____ / OUT OF ____ CHILDREN
15. HAS ANY OF YOUR SIBLINGS PARTICIPATED IN PROJECT ILHAM BEFORE THIS? Yes/No
If yes, please state their name(s):
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
16. HEALTH COMPLICATIONS: Yes/No
If yes, please state:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
17. ALLERGIES : Yes/No
If yes, please state:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
I confirm that the information I have given in this application is, to the best of my knowledge, complete
and accurate.
…………………………………………………. ………………………………………………….
Signature of Applicant Signature of Parent/Guardian
Date: Date:
RETURN TO:
PROJECT ILHAM, MALAYSIAN COMMUNITY & EDUCATION FOUNDATION, LEVEL 3A, BLOCK 1A, PLAZA SENTRAL,
JALAN STESEN SENTRAL 5, KUALA LUMPUR SENTRAL, 50470 KUALA LUMPUR
CONTACT US:
PROJECT ILHAM, MALAYSIAN COMMUNITY & EDUCATION FOUNDATION, LEVEL 3A, BLOCK 1A, PLAZA SENTRAL,
JALAN STESEN SENTRAL 5, KUALA LUMPUR SENTRAL, 50470 KUALA LUMPUR
TEL : 03-23812900 FAX : 03-23812034 E-MAIL: [email protected]
