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SCHOLARSHIP APPLICATION

CURTIN UNIVERSITY OF TECHNOLOGY, SARAWAK CAMPUS

SCHOLARSHIPS AVAILABLE AS BELOW: (PLEASE TICK ONE CATEGORY ONLY)

 International Student
Pro Vice Chancellor’s International Scholar
• Two scholarships at 50% each for entire duration of programme (3 to 4 Years dependent on
programme enrolled)

 International Foundation Student


• Two scholarships at 50% each for entire Foundation duration of programme

 Malaysian Citizen
Dean’s Scholar
• Two scholarships at 100% each for entire duration of programme (3 to 5 years dependent on
programme enrolled)

CSM First Year Scholar


100% scholarship
50% scholarship
 25% scholarship

HOW TO COMPLETE THIS APPLICATION FORM


1. Please print boldly using BLOCK LETTERS. All sections must be completed.
2. This application is the property of Curtin University of Technology, Sarawak Campus, Miri, Sarawak, Malaysia.
3. Please state NA for irrelevant sections.

PLEASE NOTE CAREFULLY


1. Application closing date is on 17th February for 1st semester (Feb – July), 23rd July for 2nd semester (Aug –
Dec) . Applications received after this date WILL NOT be considered.
2. Please attach all certified true copies of examination certificates; testimonials; evidence of extra-
curricular activities and latest e-B or e-BE Form/latest parent’s income statement and other requirement
as stated in the application form.
3. Incomplete applications will be disqualified.
4. Applications must be received in person or by post to the Loans & Scholarships Department, Student
Services Department
5. Applicants must have obtained admission to the Curtin Degree Program

Mail this form to : Loan & Scholarship Department


Curtin University of Technology, Sarawak Campus
Tel : (60) 085-443861/085-443939 ext 2004
Fax : (60 )085–443899
CDT 250, 98009 Miri Sarawak
Email : loans.scholarships@curtin.edu.my

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1.PERSONAL DETAILS
Surname

Given Names

Title Sex Female Male Birth Date


(Mr, Ms, etc) D D M M Y Y

IC No. (Malaysians) - -

Place of birth

Race/Ethnicity Religion

PRESENT CONTACT ADDRESS –Your Preferred Mailing Address


Number and Street

Suburb / Town / City Postal Code State

Country Home Phone

Hand Phone Office Phone

Email Address

PERMANENT HOME ADDRESS


Is your permanent home address the same as your present contact address?
If “No” Please complete the details below. Yes No
Number and Street

Suburb / Town / City Postal Code State

Country Home Phone

2. APPLICATION DETAILS

If Yes, Date of Application :


Have you previously applied to Curtin? D D M M Y Y
Yes No Student ID Number
If No, please download an application form from
http://www.curtin.edu.my/prospective/how2apply_local.htm and submit with this scholarship application form.

Are you are current students?   If Yes, please fill in the details below:
Yes No

Courses enrolled: ______________________________________________

Current Year of studies: ________________________________________

Which Semester? :_____________________________________________

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3. EDUCATION Provide details of your SPM/ O’ Levels/ Foundation / Matriculation / STPM / A-Levels /
UEC or equivalent

SPM/O’ Level/ Foundation/ Matriculation or STPM/UEC/A’ Level or equivalent


equivalent
School/College: School/College:
Year Year
Subjects Grades Subjects Grades

4. ENGLISH LANGUAGE PROFICIENCY Provide details with supporting documents.

Score/Grades Date taken


SPM
STPM (MUET)/ A’ Level
Others (i.e IELTS/UEC)

5. MY FAMILY INCOME IS IN THE FOLLOWING RANGE (please tick the appropriate box)

Below RM20,000 per annum


RM20,000 — RM30, 500 per annum
RM31,000 — RM41, 000 per annum
RM41,500 — RM51, 000 per annum
RM51,500 — RM60, 000 per annum
Above RM61, 000 per annum

6. CURRENT SCHOLARSHIPS OR LOANS (please tick the appropriate box)

Are you currently holding any other scholarships or loans?

□ Yes …………………………………………………………………… (please indicate)

□ No
Sponsor Start :………………………… Sponsor End :………………………..
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7. FAMILY DETAILS

Name(s) Designation/Job Title Organization

Parents/Guardian
Names Current Employment Organization/Institution
Status or Educational
level

Siblings

8. KINDLY LIST YOUR EXTRA CURRICULAR ACTIVITIES WHILE IN SCHOOL/OR WITH THE
WIDER COMMUNITY
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

9. KINDLY LIST THE AWARDS YOU HAVE RECEIVED WHILE AT SCHOOL/OR FROM THE
WIDER COMMUNITY
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

10. HAVE YOU APPLIED FOR ANY EDUCATION SCHOLARSHIP FROM ANY ORGANIZATION
OR INSTITUTION?

Yes No

If YES, give details:


__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

11. PERSONAL STATEMENT (In 200 words, write an essay on the following topic:

“Having a Curtin Sarawak Scholarship Award will enable me to reach my career goals”

________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
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12. DECLARATION & SIGNATURE(S)

I declare that all the information provided by me for this application is true. I acknowledge that Curtin
University of Technology, Sarawak Campus, Malaysia reserves the right to vary or reverse any decision
regarding this scholarship offered on the basis of incorrect or incomplete information provided by
myself.

Signature of applicant : ____________________ Date : ___________________


(DD/MM/YYYY)

Signature of Parent/ Guardian: ______________________________


(If applicant is below 16 years of age)

FOR OFFICE USE ONLY

Important checklist (Please tick at the box below)

Completed Application form with signature

Certified true copy examination result (CSM Foundation overall results (completed 2
Semesters)/SPM/ STPM/UEC/A’ Level actual results)

Certified true copies of school leaving certificate

Certifies true copies of J form/3 months payslips/Form B

Certified true copies of evidence of extra curricular activities

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