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Acknowledgement CardMUHAMMADIYAH SCHOLARSHIPIbnu Taimiyah and Ibnu Sina Awards
Photocopy of NRIC or passport
Recent Passport size photograph
Copies of all certificates obtained
Transcript of exam results
Testimonials
Letter of offer from relevant institute
Mission Statement
Appendix A: Report by referee
Self address envelope with stamp
Please submit the missing item/s by:
Name of applicant:
This is to acknowledge receipt of your application.
The application is complete
is incomplete and the following items have not been received
MUHAMMADIYAH SCHOLARSHIPIbnu Taimiyah and Ibnu Sina AwardsMuhammadiyah Association14, Jalan Selamat, Singapore 418534. Tel: 2427388
To:
From:
(Name of applicant)
(Address of applicant)
Please affix
stamp here.
APPLICATION FORMMUHAMMADIYAH SCHOLARSHIPIbnu Taimiyah and Ibnu Sina Awards
Photocopy of NRIC or passport
Recent Passport size photograph
Copies of all certificates obtained
Transcript of exam results
Testimonials
Letter of offer from relevant institute
Mission Statement
Appendix A: Report by referee
Self addressed envelope with stamp
Page 1 of 7Page 1 of 7
Friday, 10th August 2012All applications must reach Muhammadiyah Association by
Please send your application to: Muhammadiyah Scholarship 2012Muhammadiyah Association14, Jalan Selamat,Singapore 418534
Only shortlisted applicants will be interviewed.
Successfull applications will be asked to sign a letter of undertaking
and to produce two guarantors.
Please write clearly and neatly within the spaces provided.
This form comprises 7 pages including this page.
Incomplete applications will not be accepted.
Please tick the checklist below and ensure all required documents have been provided.
For official use:
Reference No: /2012
Date of Receipt:
APPLICATION FORMMUHAMMADIYAH SCHOLARSHIPIbnu Taimiyah and Ibnu Sina Awards
1. personal particulars
Name
Permanent Address:
Date of Birth: Age:
Marital Status:
Recent Photographof Applicant
(Passport Size)
Tel. (Res.)
2. referees (please see appendix A)
Mailing Address (If different from above):
H/P No:
Email:
Office No: No. of Children:
MarriedSingle
Widowed Divorced
Singapore
Nationality:NRIC / Passport No:
Singapore PR Others:
Name
Address
Name 1:
Name ofDesignation: Organisation:
Name 2:
Name ofDesignation: Organisation:
Relationship to Applicant: Mobile No: Tel. No. (Res):
NEXT-OF-KIN 1:
Name
Address
Relationship to Applicant: Mobile No: Tel. No. (Res):
NEXT-OF-KIN 2:
Page 2 of 7
APPLICATION FORM FOR MUHAMMADIYAH SCHOLARSHIP
3. academic background
Qualification Obtained
From Yr:(mm/yy)
To Yr:(mm/yy)
TERTIARY EDUCATION:
Awarding Institution
4. application history
Are you applying for any other scholarship? No Yes
If Yes, please specify which scholarship and from which organisation.
Have you ever been awarded any scholarship before? No Yes
If Yes, please specify which scholarship, what year and from which organisation.
-
-
-
Qualification Obtained
From Yr:(mm/yy)
To Yr:(mm/yy)
POST-SECONDARY EDUCATION:
Name of School / Institution
-
-
-
Qualification Obtained
From Yr:(mm/yy)
To Yr:(mm/yy)
SECONDARY EDUCATION:
Name of School
-
-
-
Name: Awarded by:
1. Name: Year: Awarded by:
1. Name: Year: Awarded by:
Have you ever applied for Muhammadiyah Scholarship? No Yes
If Yes, please specify what year.
# Please attach copies of certificates obtained and transcripts of exam results.
Page 1 of 7Page 3 of 7
APPLICATION FORM FOR MUHAMMADIYAH SCHOLARSHIP
5. work experience (current occupation first)
Job Description:
From Yr:(mm/yy)
To Yr:(mm/yy)
Name of Company
Designation: Status: Full Time Part Time
6. voluntary experience
-
1.
Job Description:
From Yr:(mm/yy)
To Yr:(mm/yy)
Name of Company
Designation: Status: Full Time Part Time
-
2.
Job Description:
From Yr:(mm/yy)
To Yr:(mm/yy)
Name of Company
Designation: Status: Full Time Part Time
-
3.
Job Description:
From Yr:(mm/yy)
To Yr:(mm/yy)
Name of Institution
Designation:
-
1.
Job Description:
From Yr:(mm/yy)
To Yr:(mm/yy)
Name of Institution
Designation:
-
1.
Page 1 of 7Page 4 of 7
APPLICATION FORM FOR MUHAMMADIYAH SCHOLARSHIP
7. intended course of study
Please provide details of the degree/diploma course that you will be or are currently pursuing.
Institution: Status: Full Time Part Time
Title of course: Duration of course: Years
Subjects Offered: Date of enrollment:
Description of course:
Do you have a confirmed letter to pursue this course? No Yes
Please attach a statement explaining why you are applying for this scholarship. What are your goalsand aspirations? What would you like to achieve after obtaining your degree / higher qualifications?Attach a separate sheet of paper. (Maximum 1500 words)
Have you ever attended any of Muhammadiyahs classes? No Yes
If yes, please name the ustadz.
Name of applicant: Signature:
8. mission statement
9. others
I confirm that the information provided by me on this form is correct. I understand that any false or inaccurate information or omission of information will render the application void and invalid.I will withdraw from the programme and reimburse any scholarship monies received if I am selected on the basis of such information.
9. declaration
Page 5 of 7
(If yes, please attach)
Date:NRIC No:
APPLICATION FORMMUHAMMADIYAH SCHOLARSHIPIbnu Taimiyah and Ibnu Sina Awards
appendix A
Name of applicant:
Name of referee:
Name of organisation: Designation:
Email: Mobile / Tel. No:
Relationship to applicant: No. of years known:
This form must be furnished by the 1st referee. Each completed report must be sealed and signed across the seal by the referee and returned to the applicant. The report by the referee must be submitted together with the application form.
1. How would you rate the applicants ability in undertaking the higher studies?
2. What do you consider to be the applicants strengths and weaknesses?
3. Additional comments by the referee. We would appreciate any information or details about the applicant which would help in assessing the application.
Page 6 of 7
REPORT BY REFEREE 1
Signature of Referee:Name of Referee:Date:
APPLICATION FORMMUHAMMADIYAH SCHOLARSHIPIbnu Taimiyah and Ibnu Sina Awards
appendix A
Name of applicant:
Name of referee:
Name of organisation: Designation:
Email: Mobile / Tel. No:
Relationship to applicant: No. of years known:
This form must be furnished by the 2nd referee. Each completed report must be sealed and signed across the seal by the referee and returned to the applicant. The report by the referee must be submitted together with the application form.
1. How would you rate the applicants ability in undertaking the higher studies?
2. What do you consider to be the applicants strengths and weaknesses?
3. Additional comments by the referee. We would appreciate any information or details about the applicant which would help in assessing the application.
Page 7 of 7
REPORT BY REFEREE 2
Signature of Referee:Name of Referee:Date: