Jeffrey Cheah Foundation – Monash Equity Scholarships Application Form SECTION 1: APPLICANT DETAILS Name (as in IC) IC no. Permanent Home Address Mailing Address E-mail address Home Telephone Mobile Telephone SECTION 2: COURSE DETAILS School Course applied Intake SECTION 3: ACADEMIC QUALIFICATIONS STPM / A-LEVEL / Equivalent Date completed SECTION 4: FAMILY DETAILS Father’s (or Guardian’s) name Occupation * Age Income per month (RM) Mother’s (or Guardian’s name Occupation* Age Income per month (RM) * If your parents / guardians are self-employed, please indicate so. For retirees, the last drawn pay slip/ income tax statement must be enclosed. Sibling Details Name Age Occupation / Student Source of financial support Other Dependents Name Age Occupation / Student Source of financial support SECTION 5: EXTRA-CURRICULAR ACTIVITIES AND COMMUNITY ENGAGEMENT SECTION 6: DOCUMENTS CHECKLIST o Copy of Identity Card o Certified True Copies of official academic records o Copy of other relevant documents eg: Latest pay-slip/ Income Tax Form, Certificates for extra- curricular activities etc. SECTION 7: PRIVACY STATEMENT AND DECLARATION Privacy Statement The protection of personal data is important to Monash University Malaysia. Any personal data collected on this form will be treated in accordance with the Personal Data Protection Notice of Monash University Malaysia accessible via http://www.monash.edu.my/. Declaration I have read the Personal Data Protection Notice provided by Monash University Malaysia pursuant to Section 7 of the Personal Data Protection Act 2010 accessible via http://www.monash.edu.my/, which includes the purposes for which my personal data is collected/processed and classes of third parties to whom Monash University Malaysia may disclose my personal data. I hereby give consent to Monash University Malaysia to process my personal data in accordance with the Personal Data Protection Notice. I declare that the information given by me in this form is correct to the best of my knowledge. I agree to abide by the conditions of the award as well as course regulations and rules, where applicable. Signature of applicant: Date: Name: Please return the completed application form via the following methods: E-mail a WORD or PDF copy to [email protected] OR Mail or courier to: Scholarship and Study Loan Administration Office Student Services Monash University Malaysia Jalan Lagoon Selatan Bandar Sunway 46150 Petaling Jaya, Selangor Darul Ehsan Malaysia Telephone: +603-5514 4428 / +603 5514 4438 .