TAN SRI LEE LOY SENG FOUNDATION

TAN SRI LEE LOY SENG FOUNDATION

SCHOLARSHIP APPLICATION FORM
[A] PERSONAL PARTICULARS / BUTIR-BUTIR PERIBADI
Name of Applicant (according to IC) / Nama Pemohon (mengikut KP)
Sex / Jantina
Race / Bangsa
If Other, please specify / Jika lain-lain, sila nyatakan
IC No. / No. Kad Pengenalan
IC Colour / Warna Kad Pengenalan
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 (if different from Permanent address) / Alamat Surat-menyurat (jika berlainan daripada Alamat tetap)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Telephone No. / No. Telefon Bimbit
Format: 000-0000000.
Home Telephone No. / No. Telefon Rumah

Area CodePhone Number
E-mail/ E-mel
[B] COURSE OF STUDY / KURSUS PENGAJIAN
Name of University/College/Educational Instituition / Nama Universiti/Kolej/ Institusi Pendidikan
Address of University/College/Educational Instituition / Alamat University/Kolej/Institusi Pendidikan

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Course of Study / Kursus Pengajian
Total Duration of Course / Jumlah Jangka masa Pengajian
Years/Tahun
Year of study currently / Tahun Pengajian sekarang
Month and Year of Commencement of Course / Bulan dan Tahun pengajian bermula
Month and Year of Completion of Course / Bulan dan Tahun pengajian tamat

Scholarships / Loans History / Sejarah Biasiswa/Pinjaman

Rows	Name of other scholarships or study loans that you have applied for to-date in relation to this Course undertaken by you (including PTPTN) / Nama biasiswa atau pinjaman pengajian yang telah anda permohonkan setakat ini berkaitan dengan Kursus ini yang diambil oleh anda (termasuk PTPTN)	Amount Per Year (RM) / Amaun Setahun (RM)	Status of Application: Successful/Not Successful/Pending / Status Permohonan: 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.
[C] EDUCATIONAL BACKGROUND / LATAR BELAKANG PENDIDIKAN

Academic/Akademik

Rows	Name of School & Educational Institution / Nama Sekolah & Institusi Pendidikan	Grade / CGPA	Year / Tahun
SPM
STPM/Matriculation
Foundation/ Diploma/ Advanced Diploma/ Degree
Other academic Qualifications/Achievements, if any

Other Academic Qualifications/Achievements, if any / Kelayakan/Pencapaian Akademik Lain, jika ada
Co-curriculum Activities / Kegiatan Kokurikulum
Other Co-Curricular Achievements, if any / Pencapaian Kokurikulum Lain, jika ada
[D] EMPLOYMENT EXPERIENCE / 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)
Additional Information on Employment / Matlumat Tambahan Mengenai Pekerjaan
[E] Expenditure budgeted per month of academic session. (Semester cost to be proportioned accordingly) / Anggaran perbelanjaan bulanan dalam sesi akademik (Bahagikan kos setiap semester dengan sewajarnya)

Types of Expenditure / Jenis Perbelanjaan

Rows	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)

Other expenses / Perbelanjaan lain
Other expenses / Perbelanjaan lain
Total per month / Jumlah sebulan (RM)

Course fees (per year) / Yuran kursus (tahunan)

Rows	Per Year (RM)/Setiap Tahun (RM)
Course Fees (per year)/ Yuran kursus (tahunan)

[E] FAMILY DETAILS / BUTIRAN KELUARGA
Family members and guardian of applicant / Ahli keluarga dan penjaga pemohon
**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)
Names of family members/guardians who contribute to the household income / Nama ahli keluarga/penjaga yang menyumbang kepada pendapatan isi rumah
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
Name of father/mother/guardian / Nama bapa/emak/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 :

Monthly Household Income / Pendapatan Bulanan Untuk Keluarga

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

Other sources of income / Nyatakan lain-lain sumber pendapatan
Total income / Jumlah Pendapatan : RM (Father/Ayah)
Total income / Jumlah Pendapatan : RM (Mother/Ibu)
Total income / Jumlah Pendapatan : RM (Guardian / Penjaga)
Total income / Jumlah Pendapatan : RM (Other Contributor/Penyumbang Lain)
Monthly Household Expenditure

Perbelanjaan Bulanan Untuk Keluarga

Types of Expenses / Jenis Perbelanjaan

Rows	Monthly (RM) / Bulanan (RM)
House Instalments/Rental / Ansuran rumah/Sewa
Electricity / Elektrik
Water / 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)
Others / Lain-lain (State the type of expenditure / Nyatakan jenis perbelanjaan)
Total / Jumlah (RM)
[G] NAMES OF TWO REFEREES (CANNOT BE RELATIVES OR FELLOW STUDENTS) / NAMA DUA REFEREE (BUKAN SAUDARA ATAU SESAMA PELAJAR)

Referees /Referee

Rows	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

[H] PERSONAL STATEMENT

Please state clearly the reasons why you wish to apply for the scholarship, and why you think the scholarship should be awarded to you. The personal statement must be written by you without help from others or AI. Please write this on a separate sheet and upload it together with supporting documents, if any.

PENYATA PERIBADI

Sila nyatakan dengan jelas sebab anda ingin memohon biasiswa, dan mengapa anda fikir biasiswa itu harus diberikan kepada anda. Kenyataan peribadi mesti ditulis oleh anda tanpa bantuan daripada orang lain atau AI. Sila tulis ini pada helaian yang berasingan dan muat naik bersama dengan dokumen sokongan, jika ada.

Checklist - Documents to Attach

Document (please mark)
Passport Size Photograph
**Malaysia Passport (White background)(35x50mm)Photo Size Requirements.
Household Income
Household Expenditure (if any)
Utilities (Latest 3 months bill)

Please state the monthly amount paid for utilities (for the last 3 months)

Rows	Electricity bill	Water bill	Telephone bill
Month 1
Month 2
Month 3

Electricity Bill
Water Bill
Telephone Bill
File Upload

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