TAN SRI LEE LOY SENG FOUNDATION

TAN SRI LEE LOY SENG FOUNDATION

SCHOLARSHIP APPLICATION FORM
[A] PERSONAL PARTICULARS / BUTIR-BUTIR PERIBADI
Name in Full / Nama Penuh*
Sex / Jantina*

MaleFemale
Race / Bangsa*

MalayChineseIndianOther
If Others, please specify
IC No. / No. Kad Pengenalan*
IC Colour / Warna Kad Pengenalan*

Blue/MyKadPink/MyKidSilver/MyTenteraRed/MyPRGreen/MyKAS
Date Of Birth / Tarikh Lahir*

MonthDayYear
Age / Umur*
Place of Birth / Tempat Lahir*
Nationality / Warganegara*
Religion / Agama*
Permanent Address / Alamat Tetap*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postal Address / Alamat Surat-menyurat*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Telephone No. / No. Telefon Bimbit*

Area CodePhone Number
Home Telephone No. / No. Telefon Rumah
E-mail*
Name of University/College / Nama Universiti/Kolej*
Address of University/College / Alamat University/Kolej*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Course of Study / Bidang Pengajian*
Total Duration of Course / Jumlah Jangkamasa Pengajian*
Years/Tahun
Year of study currently / Tahun Pengajian sekarang*

1st2nd3rd4th5th
Commencement of Course / Tahun pengajian bermula*
Completion of Course / Tahun pengajian tamat*

Scholarships / Loans History

	Name of other scholarships or study loans that you have applied for to-date in relation to this Course undertaken by you / Nama biasiswa atau pinjaman pengajian yang telah anda permohonkan setakat ini berkaitan dengan Kursus ini yang diambil oleh anda	Amount Per Year / Nilai Setahun	Successful/Not Successful/Pending / Berjaya/Tidak Berjaya/Menunggu Keputusan
1
2
3
4
5

If you have obtained PTPTN, kindly provide the approval document and quantum granted by PTPTN per year or entire course. / Jika anda telah mendapat PTPTN, sila berikan document kelulusan dan kuantum yang diberikan oleh PTPTN setahun atau keseluruhan kursus.

[B] EDUCATIONAL BACKGROUND / LATAR BELAKANG PENDIDIKAN*

	Name of School & Educational Institution / Nama Sekolah & Institusi Pendidikan	Grade / CGPA	Year / Tahun
SPM
STPM/Matriculation
Foundation/ Diploma/ Advanced Diploma/ Degree

Co-curriculum *
Other Qualifications/Achievement, if any: / Kelayakan/Pencapaian lain, jika ada
[C] EMPLOYMENT HISTORY / SEJARAH PEKERJAAN
Details of previous employment, including any temporary / casual / part time jobs (including during school holidays, if any) / Butiran pekerjaan terdahulu, termasuk sebarang pekerjaan sementara / kasual / sambilan (termasuk semasa cuti sekolah, jika ada)
[D] Monthly budgeted expenditure of the Applicant during semester / Anggaran perbelanjaan bulanan Pemohon semasa semester

Types of Expenditure / Jenis Pebelanjaan*

	Monthly (RM)/Bulanan (RM)
Transport / Pengangkutan
Accommodation (University Hostel) / Penginapan(Asrama Universiti)
Accommodation (Outside) / Penginapan(Luar)
Food / Makanan
Telephone & Internet / Telefon & Internet
Learning Materials & Books / Bahan Belajar & Buku
Personal Expenses (groceries, toiletries, clothing, etc) / Perbelanjaan Peribadi(barang runcit, peralatan madian, pakaian, dsb)
Any other expenses besides the ones listed above (Please state type of expenses) / Sebarang perbelanjaan lain selain daripada yang disenaraikan di atas (Sila nyatakan jenis perbelanjaan)

Type of other expenses
Total / Jumlah
Types of Expenditure / Jenis Pebelanjaan*

Per Year (RM)/Setiap Tahun (RM)

Course Fees / Yuran kursus
[E] FAMILY DETAILS / BUTIRAN KELUARGA
Details of immediate family members (e.g., parents & siblings), whether they live in the same house or not, as well as others residing in the same house / Butiran ahli keluarga terdekat (cth. ibu bapa & adik beradik), sama ada mereka tinggal di rumah yang sama atau tidak, serta orang lain yang tinggal di rumah yang sama *
**Occupation (If retired, state former post. If studying, state level of education and name of school/institution) / Pekerjaan (Sekiranya telah bersara, nyatakan pekerjaan terdahulu. Sekiranya sedang belajar, nyatakan peringkat pendidikan dan nama sekolah/institusi)
2. Please state if any of your siblings are receiving/have received the TSLLSF scholarship. / Sila nyatakan sekiranya terdapat adik-beradik yang sedang/telah menerima bantuan biasiswa TSLLSF.
EMPLOYMENT OF FATHER/MOTHER/GUARDIAN / PEKERJAAN BAPA/IBU/PENJAGA
Occupation / Pekerjaan
Name of Employer / Nama Majikan
Telephone No. / No. Telefon
Address Of Employer / Alamat Majikan

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If self-employed, please give a brief summary of your business / Jika anda adalah majikan/ berkerja sendiri, sila jelas dengan ringkas jenis perniagaan/pekerjaan anda :

	Per Year (RM)/Setiap Tahun (RM)
Course Fees / Yuran kursus

Monthly Household Income / Pendapatan Bulanan Untuk Keluarga*

	Father / Bapa (RM)	Mother / Ibu (RM)	Guardian / Penjaga (RM)	Other Contributor / Penyumbang Lain (RM)
Employment (Gross Salary) / Makan Gaji (Gaji Kasar)
Business / Perniagaan
Rental / Sewa
Others / Lain-lain

Others / Lain-lain (State the source of income / Nyatakan sumber pendapatan)
Total / Jumlah (Father/Ayah)
Total / Jumlah (Mother/Ibu)
Total / Jumlah (Guardian / Penjaga)
Total / Jumlah (Other Contributor/Penyumbang Lain)
Monthly Household Expenditure

Perbelanjaan Bulanan Untuk Keluarga

Types of Expenditure / Jenis Pebelanjaan*

	Monthly (RM) / Bulanan (RM)
House Instalments/Rental / Ansuran rumah/Sewa
Electricity/Water / Elektrik/Air
Telephone & Internet / Telefon & Internet
Loan Repayment (Car/Motor-bike/Appliances) / Bayaran Pinjaman (Kereta/Motosikar/barang-barang rumah)
Transport / Pengangkutan
Education / Pelajaran
Food & Groceries / Makanan & Barangan Runcit
Others / Lain-lain

Others / Lain-lain (State the type of expenditure / Nyatakan jenis perbelanjaan)
Total / Jumlah
[F] NAMES OF TWO REFEREES (SHOULD NOT BE FELLOW STUDENTS OR RELATIVES) / NAMA DUA REFEREE (BUKAN SESAMA PELAJAR ATAU SAUDARA)

Referees /Referee*

	Referee 1	Referee 2
Full Name / Nama Penuh
Email Address / Alamat Emel
Telephone No. / No. Telefon
Occupation / Pekerjaan
Years known / Jumlah Tahun Berkenalan
Relationship to applicant / Hubungan dengan pemohon

[G] Please state clearly the reasons why you wish to apply for the scholarship, must be written by the applicant personally without help from others or technology. Please enclose on a separate sheet together with supporting documents, if any.

Sila nyatakan dengan jelas alasan-alasan mengapa anda perlukan biasiswa ini, mesti ditulis oleh pemohon sendiri tanpa bantuan daripada orang lain atau teknologi. Sila guna kertas lain dan mengemukakan dokumen-dokumen sokongan, jika berkenaan.

Please state the amount of the latest 3 months bill *

Electricity Bill
Water Bill
Telephone Bill
File Upload*

Cancelof
Tick here if you have attached Personal Statement (Section G) / Tandakan di sini jika anda telah melampirkan Penyata Peribadi (Bahagian G)
Should be Empty: