Lion Parkson Foundation Scholarship

Application Form

 Form No:  
PERSONAL PARTICULARS


Name (as per NRIC):
Chinese Name:
New I/C Number: (without any ' - ' )
Age: Gender:
Race:
Nationality:
Permanent Address:
State: Postcode:
Tel. No: -

Is your Correspondence Address same with Permanent Address?

Correspondence Address:
State: Postcode :
Tel. No: -
E-mail address:
Skype Name:
* Please kindly create a Skype Account to facilitate the Preliminary Interview via Skype.
Handphone No.: -

FAMILY DETAILS

Details of all INCOME EARNERS in a family:
1.
Relationship:
Name:
NRIC No: (without any ' - ' )
Occupation:
Employers' Name:
Employers' Address:
Income per month (RM):
e.g : 2000.00

Additional Income per month (RM):
e.g : 2000.00

Total Income per month (RM):
Monthly Contribution to Family:
e.g : 2000.00


(additional details click here)


*If there's no info just leave it blank and do not enter "-" / "NA".
*Please enter the exact amount
*Note please indicate if your parents/guardian are self-employed


Household Expenditure
Type of Expenditure
Monthly (RM)
i)
House Instalments / Rental:

e.g : 1000.00

ii)
Electricity Bill:
iii)
Water Bill:
iv)
Internet Bill:
v)
Telephone / Handphone:
vi)
Satellite TV i.e. Astro bill:
vii)
Loan Repayment:

- Hire Purchase Loan
- Personal Loan
- Other Loan(s)
:


viii)
Transportation Cost:
- School Bus
- Petrol

- etc. Please specify :

:




ix)
Education Expenses for person(s):
x)
Medical Expenses:
xi)
Insurance Premium:
xii)
Food / Living Expenses:
xiii)
Others
(Please include expenses for support of other dependents, if any) :-

:



Total Expenditures (RM)
:
*If there's no info just leave it blank and do not enter "-" / "NA".
*Please enter the exact amount




No of siblings (excluding yourself):
Do you suffer from any physical disability/handicap?:

ACADEMIC BACKGROUND


Which high/secondary school were you from :
School Name :

Academic Results

SPM
ExamType :
Year Taken
:

Grade
No. of Subject
A
:
B
:
C
:
D - E
:
G
:
Year Taken
:

Grade
No. of Subject
A
:
B
:
C
:
D
:
E
:

Higher Education

For those currently studying in Universities or Institution of Higher Learning for a Diploma, Matriculation kindly provide the following details :

University / Institution:
Course / Program:
Year / Session: Duration From
(mm/yy)
To
(mm/yy)
CGPA:

MUET

Year Taken
: (yyyy)
Band
:

Other Qualifications / Achievements

Name of Institution / School
Exam / Qualification Attained
Year Attained
Grade / Score

Choice of Study

Field of Studies:
University:
Location:


EXTRA-CURRICULAR ACTIVITIES


Please insert the 5 highest achievement in each type.

Type
: Uniformed Societies
School / Instutition
Name of Club / Society / Sports Activity
Year
(Only Based on Last 2 Years)
Position Held / Level Achieved
From
(yyyy)
To
(yyyy)


Type
: Clubs / Societies
School / Instutition
Name of Club / Society / Sports Activity
Year
(Only Based on Last 2 Years)
Position Held / Level Achieved
From
(yyyy)
To
(yyyy)


Type
: Academic Competition
School / Instutition
Name of Club / Society / Sports Activity
Year
(Only Based on Last 2 Years)
Position Held / Level Achieved
From
(yyyy)
To
(yyyy)


Type
: Sports Competition
School / Instutition
Name of Club / Society / Sports Activity
Year
(Only Based on Last 2 Years)
Position Held / Level Achieved
From
(yyyy)
To
(yyyy)

ADDITIONAL INFO


In not more than 500 words, please briefly describe yourself and state reasons for wanting to study the course for which you have applied and reasons for applying for our Scholarship.


OTHERS


How did you know about this scholarship :

Do you currently hold any other scholarship or educational loan award?


Do have any relative's in Lion Group?

DECLARATION


I (Name of applicant : , NRIC No : declare that all information and details given herein are true and correct to the best of my knowledge. I understand that a misrepresentation or mission of facts required will be sufficient cause for cancellation or withdrawal of the Scholarship, if it has been granted.