SULTAN IBRAHIM JOHOR BURSARY (SIJB) 6,-%=6,()$ EDUCATION GRANT APPLICATION FORM Dear Applicant, Thank you for your interest in the SIJB-ZSIEFA 2019 Education Grant. Please complete this application form in accordance with the instructions below and submit the completed application to the Yayasan's Committee within the prescribed timeline. Kindly ensure that all supporting documentation is included, so that your application can be taken into consideration by the Committee. Instructions to Complete and Submit the Application Form 1. Ensure that all fields are completed and all supporting documentation is attached. 2. Use CAPITAL BLOCK LETTERS when completing this document. 3. All copies of supporting documentation must be certified to be true copies of the originals thereof. 4. Incomplete application forms will not be considered. 5. All requested information must be submitted, or an explanation must be given as to why you cannot provide it. Also indicate when the outstanding documentation will be available. Any outstanding documentation must be submitted as soon as it becomes available. You will not be reminded to submit any outstanding documents. 6. Arrange the documents in the order that it appears in the checklist on page 6. 7. Upload your complete application pack by emailing to the stated email address. A. PERSONAL INFORMATION D D M M Y Y Y Y Full Name : Date of Birth: Place of Birth: NRIC No.: Gender: Passport No.: Nationality: Physical Address : Email : Mobile Number : 1 Postcode :
Transcript
SULTAN IBRAHIM JOHOR BURSARY (SIJB)
EDUCATION GRANTAPPLICATION FORM
Dear Applicant,
Thank you for your interest in the SIJB-ZSIEFA 2019 Education Grant. Please complete this application form in accordance with the instructions below and submit the completed application to the Yayasan's Committee within the prescribed timeline. Kindly ensure that all supporting documentation is included, so that your application can be taken into consideration by the Committee.
Instructions to Complete and Submit the Application Form
1. Ensure that all �elds are completed and all supporting documentation is attached.2. Use CAPITAL BLOCK LETTERS when completing this document.3. All copies of supporting documentation must be certi�ed to be true copies of the originals thereof.4. Incomplete application forms will not be considered.5. All requested information must be submitted, or an explanation must be given as to why you cannot provide it. Also indicate when the outstanding documentation will be available. Any outstanding documentation must be submitted as soon as it becomes available. You will not be reminded to submit any outstanding documents.6. Arrange the documents in the order that it appears in the checklist on page 6.7. Upload your complete application pack by emailing to the stated email address.
A. PERSONAL INFORMATION
D D M M Y Y Y Y
Full Name :
Date of Birth: Place of Birth:
NRIC No.: Gender:
Passport No.: Nationality:
Physical Address :
Email :
Mobile Number :
1
Postcode :
SULTAN IBRAHIM JOHOR BURSARY (SIJB)
EDUCATION GRANTAPPLICATION FORMA. PERSONAL INFORMATION (cont.)
2
Postal Address :
Postcode :
Do you have any disabilities or chronic illness(es) :
If yes, please specify :
(Kindly attach relevant medical certi�cates to this application)
Marital Status : No. of Dependants (if any) :
Spouse Name :(if applicable)
Employed : Total Gross Monthly Income :(please provide proof )
Position :
Mobile Number :
Father’s/Guardian Name :
Employed : Total Gross Monthly Income :(please provide proof )
Position :
Mobile Number :
Mother’s Name :
Employed : Total Gross Monthly Income :(please provide proof )
Position :
Mobile Number :
Y
Y
Y
N
N
N
Grand Total of Gross Monthly Income : R M
SULTAN IBRAHIM JOHOR BURSARY (SIJB)
EDUCATION GRANTAPPLICATION FORMA. PERSONAL INFORMATION (cont.)
3
Other dependants supported by you and/or your parent(s) or guardian :
No. Full Name Relationship Age
B. APPLICANT’S EDUCATION DETAILS
Current Name of University/Institution:
Course Title :
Department :
Highest educational quali�cation :
Year of highest quali�cation received :Name of School/University/Institution:
Current Tertiary Education : Undergraduate Postgraduate
Year of Study : Semester :
Expected Year Completion of Study :
Secondary or Tertiary education results :(Please provide full academic transcripts)
Please attach evidence (certi�cate/letter of acknowledgment/etc) if any.
/ semester / year
Accommodation Fees :
/ semester / year
Are you currently receiving other �nancial assistance? YES NO
If yes, please provide the following details : Scholarship Bursary Loan
Total Amount :
Financial Assistance provider :
Total Amount :additional provider (if any)
Are you currently taking any part-time job(s)? YES NO
If yes, please provide the details :
Amount earned from part-time job(s) :
SULTAN IBRAHIM JOHOR BURSARY (SIJB)
EDUCATION GRANTAPPLICATION FORME. TWO (2) - MINUTE VIDEO
5
F. REFEREES
A two (2) - minute video created by the applicant must be included in the submission pack and should contain the following information :
• Introduction about yourself : Your name; where do you come from?; What is your �eld of study and university name?; A brief personal background. • Your family background• Your quali�cations and achievements• Why do you require the funds?• What is your vision?• How can you contribute to Malaysia’s nation-building?
Video Format : MP4, QuickTime, WMVLayout/Orientation : Landscape
I will use this assistance to pay the costs associated with my programme of studies and/or my accommodation fees. I authorise Yayasan Raja Zarith So�ah Negeri Johor (YRZSNJ), and any other appropriate authority and educational institution to collect, use and disclose data and information to verify any information related to any loan and / or grant that I may or may not have for the purpose of carrying out their duties under the administration and enforcement of any relevant laws in Malaysia.
I certify that I have given complete and true information on this form and I understand that failure to do so may prevent my qualifying for assistance for this bursary grant and in the future. I understand that if I receive a bursary grant from this Fund, it is awarded to me on the condition that it will be used for the purposes for which it was intended as stated above. I understand that if I do not respect this condition, it may result in my loss of eligibility for future grant funding and possible legal action by the YRZSNJ.
I understand that, in respect of this �nancial assistance, if I knowingly make a false statement or misrepresentation in the application or other document(s) or wilfully provide any false or misleading information, I am guilty of an o�ence under the relevant laws and liable for a �ne or summary conviction.
SIGNATURE OF APPLICANT :
D D M M Y Y Y YDATE :
Supporting document checklist (√)
1. Completed SIJB-ZSIEFA 2019 Application Form2. Copy of NRIC/Passport3. Medical Certi�cates (if relevant)4. Proof of Monthly Household Income & Dependants5. Copy of all Academic Transcripts and Certi�cates to date (SPM/A-level/O level/Bachelor’s/Honours/Masters/PhD)6. Copy of Certi�cates of Extra-curricular/Organisational Activities & Community Involvement (if any)7. A two (2)-minute video
H. SUBMISSION PROCESS AND DEADLINES
1. Applications must be submitted via email to : [email protected]. Applications must be submitted by no later than 3rd of March 2019, 12am Malaysia Time (MYT).3. Applications must be submitted as a single pdf document.4. All applications will be acknowledged by email within 2 weeks of receipt. 5. The YRZSNJ Committee will review all applications and will communicate the outcome to successful applicants by the 23rd of March 2019.6. Should you not hear back from us within the time frame contemplated in paragraph 5, please regard your application as having been unsuccessful.7. Any determination or decision of the YRZSNJ Committee regarding the outcome of this application will be �nal and binding on the applicant and no correspondence will be entered into with unsuccessful candidates.
