APPLICATION FORMMUHAMMADIYAH SCHOLARSHIPIbnu Taimiyah and Ibnu Sina Awards

Photocopy of NRIC or passport

Recent Passport size photograph

Copies of all certificates obtained

Transcript of exam results

Testimonials

Letter of offer from relevant institute

Mission Statement

Appendix A: Report by referee

Self addressed envelope with stamp

Page 1 of 7Page 1 of 7

Tuesday, 30th June 2015All applications must reach Muhammadiyah Association by

Please send your application to: Muhammadiyah Scholarship 2015MWH Corporate Communications & Resource Unit58 Bedok North St 3Singapore 469624

Only shortlisted applicants will be interviewed.

Successfull applications will be asked to sign a letter of undertaking

and to produce two guarantors.

Please write clearly and neatly within the spaces provided.

This form comprises 7 pages including this page.

Incomplete applications will not be accepted.

Please tick the checklist below and ensure all required documents have been provided.

For official use:

Reference No: /2015

Date of Receipt:

Friday, 4th November 2016

2016

2016

Ibnu Taimiyah and/or Ibnu Sina AwardsIbnu Taimiyah and/or Ibnu Sina Awards

Friday, 4th November 2016

2016

APPLICATION FORMMUHAMMADIYAH SCHOLARSHIPIbnu Taimiyah and Ibnu Sina Awards

1. personal particulars

Name

Permanent Address:

Date of Birth: Age:

Marital Status:

Recent Photographof Applicant

(Passport Size)

Tel. (Res.)

2. referees (please see appendix A)

Mailing Address (If different from above):

H/P No:

Email:

Office No: No. of Children:

MarriedSingle

Widowed Divorced

Singapore

Nationality:NRIC / Passport No:

Singapore PR Others:

Name

Address

Name 1:

Name ofDesignation: Organisation:

Name 2:

Name ofDesignation: Organisation:

Relationship to Applicant: Mobile No: Tel. No. (Res):

NEXT-OF-KIN 1:

Name

Address

Relationship to Applicant: Mobile No: Tel. No. (Res):

NEXT-OF-KIN 2:

Page 2 of 7

Ibnu Taimiyah and/or Ibnu Sina AwardsIbnu Taimiyah and/or Ibnu Sina Awards

APPLICATION FORM FOR MUHAMMADIYAH SCHOLARSHIP

3. academic background

Qualification Obtained

From Yr:(mm/yy)

To Yr:(mm/yy)

TERTIARY EDUCATION:

Awarding Institution

4. application history

Are you applying for any other scholarship? No Yes

If Yes, please specify which scholarship and from which organisation.

Have you ever been awarded any scholarship before? No Yes

If Yes, please specify which scholarship, what year and from which organisation.

-

-

-

Qualification Obtained

From Yr:(mm/yy)

To Yr:(mm/yy)

POST-SECONDARY EDUCATION:

Name of School / Institution

-

-

-

Qualification Obtained

From Yr:(mm/yy)

To Yr:(mm/yy)

SECONDARY EDUCATION:

Name of School

-

-

-

Name: Awarded by:

1. Name: Year: Awarded by:

1. Name: Year: Awarded by:

Have you ever applied for Muhammadiyah Scholarship? No Yes

If Yes, please specify what year.

# Please attach copies of certificates obtained and transcripts of exam results.

Page 1 of 7Page 3 of 7

APPLICATION FORM FOR MUHAMMADIYAH SCHOLARSHIP

5. work experience (current occupation first)

Job Description:

From Yr:(mm/yy)

To Yr:(mm/yy)

Name of Company

Designation: Status: Full Time Part Time

6. voluntary experience

-

1.

Job Description:

From Yr:(mm/yy)

To Yr:(mm/yy)

Name of Company

Designation: Status: Full Time Part Time

-

2.

Job Description:

From Yr:(mm/yy)

To Yr:(mm/yy)

Name of Company

Designation: Status: Full Time Part Time

-

3.

Job Description:

From Yr:(mm/yy)

To Yr:(mm/yy)

Name of Institution

Designation:

-

1.

Job Description:

From Yr:(mm/yy)

To Yr:(mm/yy)

Name of Institution

Designation:

-

1.

Page 1 of 7Page 4 of 7

APPLICATION FORM FOR MUHAMMADIYAH SCHOLARSHIP

7. intended course of study

Please provide details of the degree/diploma course that you will be or are currently pursuing.

Institution: Status: Full Time Part Time

Title of course: Duration of course: Years

Subjects Offered: Date of enrollment:

Description of course:

Do you have a confirmed letter to pursue this course? No Yes

Please attach a statement explaining why you are applying for this scholarship. What are your goalsand aspirations? What would you like to achieve after obtaining your degree / higher qualifications?Attach a separate sheet of paper. (Maximum 1500 words)

Have you ever attended any of Muhammadiyah’s classes? No Yes

If yes, please name the ustadz.

Name of applicant: Signature:

8. mission statement

9. others

I confirm that the information provided by me on this form is correct. I understand that any false or inaccurate information or omission of information will render the application void and invalid.I will withdraw from the programme and reimburse any scholarship monies received if I am selected on the basis of such information.

9. declaration

Page 5 of 7

(If yes, please attach)

Date:NRIC No:

APPLICATION FORMMUHAMMADIYAH SCHOLARSHIPIbnu Taimiyah and Ibnu Sina Awards

appendix A

Name of applicant:

Name of referee:

Name of organisation: Designation:

Email: Mobile / Tel. No:

Relationship to applicant: No. of years known:

This form must be furnished by the 1st referee. Each completed report must be sealed and signed across the seal by the referee and returned to the applicant. The report by the referee must be submitted together with the application form.

1. How would you rate the applicant’s ability in undertaking the higher studies?

2. What do you consider to be the applicant’s strengths and weaknesses?

3. Additional comments by the referee. We would appreciate any information or details about the applicant which would help in assessing the application.

Page 6 of 7

REPORT BY REFEREE 1

Signature of Referee:Name of Referee:Date:

Ibnu Taimiyah and/or Ibnu Sina Awards

APPLICATION FORMMUHAMMADIYAH SCHOLARSHIPIbnu Taimiyah and Ibnu Sina Awards

appendix A

Name of applicant:

Name of referee:

Name of organisation: Designation:

Email: Mobile / Tel. No:

Relationship to applicant: No. of years known:

This form must be furnished by the 2nd referee. Each completed report must be sealed and signed across the seal by the referee and returned to the applicant. The report by the referee must be submitted together with the application form.

1. How would you rate the applicant’s ability in undertaking the higher studies?

2. What do you consider to be the applicant’s strengths and weaknesses?

3. Additional comments by the referee. We would appreciate any information or details about the applicant which would help in assessing the application.

Page 7 of 7

REPORT BY REFEREE 2

Signature of Referee:Name of Referee:Date:

Ibnu Taimiyah and/or Ibnu Sina Awards