Power of Education Scholarship - MyUM - Universiti Malaya

Scholarhip Program from:
Managed by:
Borang Permohonan / Application form for
National Semiconductor “Power of Education Scholarship”
1. Maklumat Peribadi / Personal Information
Nama /Name :
……………………………………………………………………………………………
No. Kad Pengenalan / Identity Card No: ……………….
Alamat Rumah/ Home Address:
…………………………………………………………………………………………………………………
………………………………………………………………………………………………………………. ..
…………………………………………………… Poskod/Postcode …………………….
No. Tel./ Tel. No: ………………………….. E mel/ E-mail: …………………………………..
2. Maklumat Institusi Pengajian/ Information on Institution/University
Nama Institusi/ Name of Institution/University:
[ Universiti Malaya (UM) ]
[Universiti Kebangsaan Malaysia (UKM) ]
Bidang Pengajian/Field of Study:
[Electrical Engineering]
[Electronics]
[Physics]

Tempoh Pengajian/ Duration of Study………… Tahun/Year
Mula/Start (Bulan/Month : …………………………………….
Tahun/Year) : ……………………………………
Tamat/ End (Bulan/Month : …………………………………….
Tahun/Year) : ……………………………………
Yuran Pengajian Setahun/ Tution Fees Yearly: ……………………………………
(Sertakan salinan surat pengesahan dari Universiti/ Attach a copy of the confirmation letter of
acceptance from University)
3. Maklumat Ibu/Bapa/Penjaga/ Information on Mother/Father/Guardian
Nama Ibu/ Bapa/Penjaga/ Name of Mother/Father/Guardian :
……………………………………………………………………………………………
No. Kad Pengenalan / Identity Card No: ……………….
Perkerjaan/ Occupation: …………………………………………………………….
Alamat Majikan/ Name of Employer ………………………………………………
(Jika ada/ If any) …………………………………………………………………….
………………………………………………………………………
Pendapatan Bulanan/ Monthly Income: ……………………………………………
Adakah anda mempunyai ahli keluarga atau saudara yang berkeja di National Semiconductor/ do
you have a family member or relative working at National Semiconductor [ YES / NO ]
Jika Ya, sila berikan nama dan jawatan beliau / If Yes, please give name and position of person
……………………………………….
4. Kenyataan Peribadi /Personal Statement
Apakah tujuan pendidkan dan kerjaya professional anda Bagaimanakah
biasiswa ini boleh membantu anda untuk mencapai tujuan tersebut What are your educational
and professional goals and how will a Power of Education Scholarship help you achieve them

5. Perakuan/ Declaration
Saya mengaku bahawa segala maklumat yang diberi adalah betul dan benar. Saya juga difaham jika
keterangan yang diberikan di atas didapati palsu, pihak The Asia Foundation berhak untuk
menolak permohanan saya./ I hereby declare that all information given is correct and true. I
understand that if any information given is found to be false, The Asia Foundation has the right to
reject my application.
Tarikh/Date
6. Pengesahan / Verification
__________________________________
Tandatangan Pemohon/ Signature of Applicant
( hendaklah disahkan oleh Guru Besar/ Pengetua Sekolah Menengah /has to be completed by
Headmaster/Principal of Secondary School.
Saya mengaku bahawa segala maklumat yang diberi oleh calon No. K/P …………………………
dalam Borang ini adalah betul dan benar./ I, hereby declare that all the information given by
candidate I.C No……………………..
Is correct and true.
Tandatangan/ Signature
Nama/ Name :
Alamat/Address :
Pekerjaan/ Occupation :
No Kad Pengenalan/ IC No:
Cop Rasmi/ Official chop:
Tarikh/ Date :