Application for UniMy Merit ScholarshipsThis form should be completed and returned along with certified true copies of all supporting documents to the following address:

Head, Student Affairs,University Malaysia of Computer Science & Engineering,Menara Z10, Ground Floor,Jalan Alamanda 2, Precinct 1,62000 Putrajaya, Wilayah Persekutuan.

Please complete this form in BLOCK LETTERS and in BLACK.

www.UniMy.edu.my | Programming the Future

For Office Use OnlyApplication No:

FOUNDATION: January - 15 Dec 2013April - 31 Mar 2014July - 14 Jul 2014

DEGREE:February - 28 Feb 2014June - 26 May 2014September - 02 Sep 2014

A. Application DetailsProgramme of Study:

Academic Year: Intake:

B. Personal Details Full Name (as per NRIC):

Gender: NRIC / Passport No:

Date of Birth: Age:

Marital Status: Race: Religion:

Permanent Address: Email Address:

Home Phone:

Mobile Phone:

Postcode: City: State:

C. Academic Qualification

F SPM F STPM F Matriculation F Diploma F SAM F IB F CAL F CPU F OTHERS

School / Institution: Year Taken:

Subject Grade Subject Grade

MUET / IELTS / TOEFL: (Band / IBT) _______

D. Extra-Curricular ActivitiesGames / Societies / Others Position Held / Achievements Year

CLOSING DATES

E. Details of Father / GuardianName of Father / Guardian:

Citizenship: New NRIC No: Old NRIC No:

Date of Birth: Place of Birth:

Home Phone: Mobile Phone:

Occupation: Monthly Income:

Name & Address of Employer: Signature:

F. Details of Mother / GuardianName of Mother / Guardian:

Citizenship: New NRIC No: Old NRIC No:

Date of Birth: Place of Birth:

Home Phone: Mobile Phone:

Occupation: Monthly Income:

Name & Address of Employer: Signature:

G. Details of Siblings

No Name Age Date of Birth Occupation / Student Employer / School

1.

2.

3.

4.

5.

www.UniMy.edu.my | Programming the Future

Application for UniMy Merit Scholarships

H. DeclarationI declare that the information provided by me in this form is true and correct. I have read the information and all terms and conditions stipulated herein this application form, and agree that UniMy reserves the right to vary or reverse any decision regarding this application made on the basis of incorrect or incomplete information.

Name: Applicant’s Signature:

Date:

I. For Office UseDate Received: Signature:

Note: Please check the availability and verification of the following documents and attached them with your application. F Certified true copy of NRICs of applicant and parents / guardian F Certified true copy of examination results F Certified true copy of co-curricular activities certificates / testimonials F Certified true copy of parents / guardian latest salary slip

Application for UniMy Merit Scholarships

J. Terms & Conditions1. The scholarship offered is only valid for year 2014. If the scholarship offer is not exercised within the year of offer, it shall lapse

automatically.2. As scholarship awards are limited and competitive, only candidates who meet the minimum criteria specified are eligible to apply.3. Meeting the minimum criteria does not automatically guarantee the applicant a scholarship.4. Scholarship offered is not exchangeable, nor is the unutilised portion of the scholarship refundable in cash.5. The scholarship is not applicable for payment of re-sit/re-enrolment fees.6. The scholarship is not applicable for non-Malaysians.7. All information furnished by the scholarship recipient must be true and correct in all respects. In the event of any inaccurate or

incorrect information furnished, the scholarship is liable to be withdrawn without notice and in such event, the scholarship recipient shall be required to pay University Malaysia of Computer Science & Engineering (UniMy) the amount of tuition fees waived to date.

8. All scholarship applications will be evaluated and short-listed by the Scholarship Committee of UniMy.9. For students who have applied to join a chosen programme, he/she is expected to register during the intake date and is required to

pay all administration and course fees by the last day of payment pending the decision of the Scholarship Committee. Otherwise, the scholarship application is considered null and void.

10. For Foundation programmea. Full scholarship holders must complete the programme with minimum CGPA 3.0 to be eligible for consideration of the scholarship

at the under graduate level. b. Partial scholarship and bursary holders must complete the programme with minimum CGPA 2.75 and CGPA 2.5 respectively to

be eligible for consideration of the scholarship at the under graduate level.11. For Under Graduate programmes:

a. Full scholarship holders must attain a minimum CGPA 3.0 to be eligible for continuation of the scholarship for the following year.b. Partial scholarship and bursary holders must attain a minimum CGPA 2.75 and CGPA 2.5 respectively to be eligible for

continuation of the scholarship for the following year.12. All recipients of scholarship are required to contribute up to 5 hours per week of their time to assist the Head of Department or their

designate in administration, peer counselling, extra-curricular activities, marketing and promotional activities.13. UniMy reserves the right to revoke the said scholarship if the recipient does not maintain discipline, failure to attain the required

academic standard, attendance and good behaviour and/or participates in criminal or tortuous acts of omissions.14. Late and incomplete application forms will not be considered for selection.15. UniMy reserves the right to amend the policies and term of the scholarship without notice.16. All decisions made by UniMy on matters pertaining to the scholarship will be final.

www.UniMy.edu.my | Programming the Future

For Inquiries University Malaysia of Computer Science & Engineering (UniMy)Menara Z10, Ground Floor, Jalan Alamanda 2, Precinct 1,62000 Putrajaya, Wilayah Persekutuan.T:+6 03 8800 5000 F:+6 03 8800 5011 E info@UniMy.edu.my

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AGENCY’S SIGNATURE & STAMP

DATE: