SECONDARY SCHOOL SCHOLARSHIP APPLICATION FORM

YEAR 2020 - 2021

KINGSLEY INTERNATIONAL SCHOOL (KIS) SECONDARY SCHOOL SCHOLARSHIP

The Kingsley International School High School Scholarship Programme offers partial scholarship to successful applicants who achieved the UPSR public examination and is keen to enroll in an international curriculum for Year 7. Applicant is also required to pass the KIS’s placement test and attend a brief interview. The award of this scholarship is based on the competency of the student’s academic performance and attitude towards involvement in community activities.

This Scholarship is for a student who will: Enter Year 7 for academic Year 2020/2021 – a scholarship offering that offers FULL waiver on tuition fee for the first term of Year 7 in September, and a successful scholarship waiver on tuition fees for Term 2 and 3. For all subsequent levels (Year 8, 9, 10, 11 and 12) all termly tuition fees will be waived with the same scholarship percentage awarded.

The scholarship is available to a student who have completed Cambridge Year 6 Checkpoint or Standard 6 and passed UPSR in the year 2020 and is not available to students currently holding external scholarships/bursaries.

Please fill up the application form completely. It must be returned to:

Kingsley Registrar Office By/before: 30th April 2020.

Academic Standards Academic Performance – UPSR or Cambridge Year 6 Checkpoint Exams

The applicant would have excellent academic performance across the whole spectrumof subjects rather than just being exemplary in one or two subjects.The emphasis is both on excellence of exam results and consistency of performance inschool.The following results are expected:Standard 6 (UPSR) - A minimum of 5As (UPSR trial examinations) ORCambridge Year 6 Checkpoint - A score of 6.0 in English, Mathematics and Science.Applicants must submit results from their own school Year-6 trial examinations besidesitting for Kingsley placement exams prior to enrolment.

School Activity and Community Involvement

1 - Scholarship candidates will be expected to support their excellent academic credentials with a clear and consistent commitment to one of the following in KIS: (candidate to choose one of the box below)

The Gavel Club The Interact Club The Scouts This will be a compulsory activity throughout their entire Scholarship period in KIS.

2 - In addition to one ECA Sports of their own choice from the list provided by the school. 3 - The candidate becomes a member of the KIS Student Council immediately upon successful

enrolment.

Personal Essay Statement In Section E, please write a brief essay (approximately 150 words) to highlight: 1 - your strengths and involvement in any school community activities. 2 – your take and belief in living in a healthy and safe community. This must be submitted along with your completed application.

Terms and Conditions

1) Kingsley International School (KIS) is awarding:a) a FULL waiver on tuition fee for the first term of Year 7b) and the granted scholarship for each subsequent term to the successful applicant.

2) The applicant has accepted the award for the purpose of pursuing his/her high schoolin KIS to the terms, conditions and stipulations hereinafter set out.

3) The applicant can apply for the KIS Scholarship based on school trial results startingMarch 2020 and will be shortlisted after sitting for KIS placement test and aninterview.

4) For the actual selection, KIS will only award the scholarship to applicant based on:a) actual individual school UPSR trial examination results scoring a minimum of5 As (including English, Mathematics and Science subjects).b) passing KIS’s placement test and interview.

5) The applicant hereby agrees and undertakes as follows :

.1

.2

.3

.4

.5

.6

To attend full time, regularly, diligently (except on medical or other temporary incapacity) all classes, tutorials and lessons as required by KIS.

To maintain all CA (Continuous Assessments) and examination result each semester, scoring A in 5 subjects (including English, Mathematics and Science).

The applicant will be given a Letter of Caution or a ‘At Risk Letter’ leading to the revoking of the scholarship. (after the issuance of second letter)

The successful applicant is required to assist in any activities as organized by the Marketing and Service Department without disrupting the class activities and attendance, This may fall on weekends or holidays, however, prior notifications will be given to the student.

Not to be involved, engaged in or participate in any activity or society, or to do anything illegal or unlawful under the Malaysian law or as per the KIS Rules and Policies.

To practice exemplary behavior and to comply with all rules and regulations in accordance to the Student/Parent Handbook.

.7 To show leadership and be involved proactively in leadership programs, events voluntarily or being selected by KIS.

.8 Not to hold KIS obligated to continue to extend the award beyond the academic period.

.9 The successful applicant is not allowed to a) abandonb) discontinue orc) change schoolwhilst under this scholarship contract. If under any circumstances that thesuccessful applicant decided to quit the school, he/she is to pay all the feeswaived from all previous semesters to KIS.

6) All decisions made by KIS on matters pertaining to the scholarship will be final.

7) KIS reserves the right to revoke any scholarship due to failure in examinations,withdrawal from program before completion and/or non-compliance with the Rules andRegulations of Kingsley International School.

Kingsley International School Persiaran Kingsley, Kingsley Hill, Putra Heights, 47650 Subang Jaya, Selangor.

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kis KISB-FM-124 (1)

Rev.date: 19 Feb 2020

HIGH SCHOOL SCHOLARSHIP APPLICATION FORM

INSTRUCTIONS 1. Please fill up the application form in BLOCK LETTERS.2. Each applicant is allowed to submit only ONE application3. All fields in the form must be filled up and not left blank.4. Only shortlisted candidates will be notified for interview.5. Incomplete application forms that do not comply with the eligibility criteria WILL

NOT be considered.6. Please send the duly completed form with all the required supporting documents to

Kingsley Registrar Office.

TUDENT DATA

FULL NAME : ___________________________________________________________ (Write clearly in BLOCK LETTER)

GENDER : ____________________________________________________________

DATE OF BIRTH : ______________________ PLACE OF BIRTH : ___________________

NRIC NO : ______________________

Postal Address: _________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

State: _________________________________ Postcode: ___________________________

Telephone (resident): _____________________ Mobile No: _________________________

Email: ________________________________________________________________________

Current education level: ________________________________________________________

Level year to enroll in: ___________________

Passport sized photograph

KISB-FM-124 (1) Rev.date: 19 Feb 2020

ETAILS OF PARENTS

FATHER'S NAME MOTHER'S NAME

NRIC NO. NRIC NO.

OCCUPATION OCCUPATION

OFFICE NAME & ADDRESS OFFICE NAME & ADDRESS

OFF CE TEL NO. OFFICE TEL. NO.

NO. NO.

Are your parents financing your studies? Yes No

If , please

NAME: NRIC NO:

RELATIONSHIP: OCCUPATION:

Kingsley International School Persiaran Kingsley, Kingsley Hill, Putra Heights, 47650 Subang Jaya, Selangor.

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kis KISB-FM-038

Rev.date: 7Feb2020

HIGH SCHOOL SCHOLARSHIP APPLICATION FORM

INSTRUCTIONS1. Please fill up the application form in BLOCK LETTERS.2. Each applicant is allowed to submit only ONE application3. All fields in the form must be filled up and not left blank.4. Only shortlisted candidates will be notified for interview.5. Incomplete application forms that do not comply with the eligibility criteria WILL

NOT be considered.6. Please send the duly completed form with all the required supporting documents to

Kingsley Registrar Office.

A. STUDENT DATA

FULL NAME : ___________________________________________________________ (Write clearly in BLOCK LETTER)

GENDER : ____________________________________________________________

DATE OF BIRTH : ______________________ PLACE OF BIRTH : ___________________

NRIC NO : ______________________

Postal Address: _________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

State: _________________________________ Postcode: ___________________________

Telephone (resident): _____________________ Mobile No: _________________________

Email: ________________________________________________________________________

Current education level: ________________________________________________________

Level year to enroll in: ___________________

Passport sized photograph

Your Financial Sponsor’s Details:

KISB-FM-038Rev.date: 7Feb2020

ETAILS OF PARENTS

FATHER'S NAME MOTHER'S NAME

NRIC NO. NRIC NO.

OCCUPATION OCCUPATION

OFFICE NAME & ADDRESS OFFICE NAME & ADDRESS

OFF CE TEL NO. OFFICE TEL. NO.

NO. NO.

Are your parents financing your studies? Yes No

If , please

NAME: NRIC NO:

RELATIONSHIP: OCCUPATION:

Kingsley International SchoolKingsley House, 2, 12, 12A & 16, Jalan Putra Mahkota 7/8E, Putra Heights, 47650 Subang Jaya, Selangor

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kisKISB-FM-038

Rev.date: 7Feb2020

HIGH SCHOOL SCHOLARSHIP APPLICATION FORM

INSTRUCTIONS1. Please fill up the application form in BLOCK LETTERS.2. Each applicant is allowed to submit only ONE application3. All fields in the form must be filled up and not left blank.4. Only shortlisted candidates will be notified for interview.5. Incomplete application forms that do not comply with the eligibility criteria WILL

NOT be considered.6. Please send the duly completed form with all the required supporting documents to

Kingsley Registrar Office.

A. STUDENT DATA

FULL NAME : ___________________________________________________________ (Write clearly in BLOCK LETTER)

GENDER : ____________________________________________________________

DATE OF BIRTH : ______________________ PLACE OF BIRTH : ___________________

NRIC NO : ______________________

Postal Address: _________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

State: _________________________________ Postcode: ___________________________

Telephone (resident): _____________________ Mobile No: _________________________

Email: ________________________________________________________________________

Current education level: ________________________________________________________

Level year to enroll in: ___________________

Passport sized photograph

I

KISB-FM-038Rev.date: 7Feb2020

ACADEMIC STANDARDS

Applicant is required to provide details of the UPSR examination and school trial examination in the space below.

Applicants may highlight any significant academic success

Name of School: Year:

Address of school: _____________________________________________________________

UPSR Subjects and Results

01 06

02 07

03 08

04 09

05 10

Academic Awards / Other Qualifications

No Name of Examination/Award Grade/Award

01

02

03

04

05

Kingsley International SchoolKingsley House, 2, 12, 12A & 16, Jalan Putra Mahkota 7/8E, Putra Heights, 47650 Subang Jaya, Selangor

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kisKISB-FM-038

Rev.date: 7Feb2020

HIGH SCHOOL SCHOLARSHIP APPLICATION FORM

INSTRUCTIONS1. Please fill up the application form in BLOCK LETTERS.2. Each applicant is allowed to submit only ONE application3. All fields in the form must be filled up and not left blank.4. Only shortlisted candidates will be notified for interview.5. Incomplete application forms that do not comply with the eligibility criteria WILL

NOT be considered.6. Please send the duly completed form with all the required supporting documents to

Kingsley Registrar Office.

A. STUDENT DATA

FULL NAME : ___________________________________________________________ (Write clearly in BLOCK LETTER)

GENDER : ____________________________________________________________

DATE OF BIRTH : ______________________ PLACE OF BIRTH : ___________________

NRIC NO : ______________________

Postal Address: _________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

State: _________________________________ Postcode: ___________________________

Telephone (resident): _____________________ Mobile No: _________________________

Email: ________________________________________________________________________

Current education level: ________________________________________________________

Level year to enroll in: ___________________

Passport sized photograph

No. Subject Grade No. Subject Grade

Kingsley International SchoolKingsley House, 2, 12, 12A & 16, Jalan Putra Mahkota 7/8E, Putra Heights, 47650 Subang Jaya, Selangor

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kisKISB-FM-038

Rev.date: 7Feb2020

E. DECLARATION

I, , I/C No.

father/mother/guardian of do hereby certifythat all information provided in this application are true and accurate to the best of myknowledge and have not withheld any material information which might influence theconsideration of this application.

I understand that KIS reserves the right to vary or reverse any decision regarding scholarship status made of the basis of incorrect or incomplete information.

_________________________________ Date: ______________________________ Parent’s sign

==================================================================== FOR OFFICE USE ONLY

General Observations & Comments

Application received by: ________________________________ Date: ________________________

Shortlisted Yes No

Scholarship Approved Yes No

Scholarship approved/rejected by: Date:

_______________________________________ _______________________________

Attitude & Character Grooming & Disposition

%

Kingsley International SchoolKingsley House, 2, 12, 12A & 16, Jalan Putra Mahkota 7/8E, Putra Heights, 47650 Subang Jaya, Selangor

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kisKISB-FM-038

Rev.date: 7Feb2020

E. DECLARATION

I, , I/C No.

father/mother/guardian of do hereby certifythat all information provided in this application are true and accurate to the best of myknowledge and have not withheld any material information which might influence theconsideration of this application.

I understand that KIS reserves the right to vary or reverse any decision regarding scholarship status made of the basis of incorrect or incomplete information.

_________________________________ Date: ______________________________ Parent’s sign

==================================================================== FOR OFFICE USE ONLY

General Observations & Comments

Application received by: ________________________________ Date: ________________________

Shortlisted Yes No

Scholarship Approved Yes No

Scholarship approved/rejected by: Date:

_______________________________________ _______________________________

Attitude & Character Grooming & Disposition

%

Your Financial Sponsor’s Details:Your Financial Sponsor’s Details:

UPSR Subjects and Results

Subjects Grad Subjects Grad

1

2

3

4

5

6

7

8

Academic Awards / Other Qualifications

Name of Examination / Award Grad / Award

1

2

3

4

UPSR Subjects and Results

Subjects Grad Subjects Grad

1

2

3

4

5

6

7

8

Academic Awards / Other Qualifications

Name of Examination / Award Grad / Award

1

2

3

4

UPSR Subjects and Results

Subjects Grad Subjects Grad

1

2

3

4

5

6

7

8

Academic Awards / Other Qualifications

Name of Examination / Award Grad / Award

1

2

3

4

Kingsley International SchoolKingsley House, 2, 12, 12A & 16, Jalan Putra Mahkota 7/8E, Putra Heights, 47650 Subang Jaya, Selangor

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kisKISB-FM-038

Rev.date: 7Feb2020

E. DECLARATION

I, , I/C No.

father/mother/guardian of do hereby certifythat all information provided in this application are true and accurate to the best of myknowledge and have not withheld any material information which might influence theconsideration of this application.

I understand that KIS reserves the right to vary or reverse any decision regarding scholarship status made of the basis of incorrect or incomplete information.

_________________________________ Date: ______________________________ Parent’s sign

==================================================================== FOR OFFICE USE ONLY

General Observations & Comments

Application received by: ________________________________ Date: ________________________

Shortlisted Yes No

Scholarship Approved Yes No

Scholarship approved/rejected by: Date:

_______________________________________ _______________________________

Attitude & Character Grooming & Disposition

%

Kingsley International SchoolKingsley House, 2, 12, 12A & 16, Jalan Putra Mahkota 7/8E, Putra Heights, 47650 Subang Jaya, Selangor

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kisKISB-FM-038

Rev.date: 7Feb2020

E. DECLARATION

I, , I/C No.

father/mother/guardian of do hereby certifythat all information provided in this application are true and accurate to the best of myknowledge and have not withheld any material information which might influence theconsideration of this application.

I understand that KIS reserves the right to vary or reverse any decision regarding scholarship status made of the basis of incorrect or incomplete information.

_________________________________ Date: ______________________________ Parent’s sign

==================================================================== FOR OFFICE USE ONLY

General Observations & Comments

Application received by: ________________________________ Date: ________________________

Shortlisted Yes No

Scholarship Approved Yes No

Scholarship approved/rejected by: Date:

_______________________________________ _______________________________

Attitude & Character Grooming & Disposition

%

UPSR Subjects and Results

Subjects Grad Subjects Grad

1

2

3

4

5

6

7

8

Academic Awards / Other Qualifications

Name of Examination / Award Grad / Award

1

2

3

4

Kingsley International SchoolKingsley House, 2, 12, 12A & 16, Jalan Putra Mahkota 7/8E, Putra Heights, 47650 Subang Jaya, Selangor

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kisKISB-FM-038

Rev.date: 7Feb2020

D. SCHOOL COMMUNITY INVOLVEMENT

Applicants are invited to list examples of their school community involvement using the list on the front page as a guideline regarding what to include.

Please provide or attach all photocopy of certificates as proof of participation.

Student’s Sign: _______________________ Parent’s Sign: __________________________

Date: _______________________ Date: _________________________________

D. PARTICIPATION IN SCHOOL ACTIVITIES & CSR

Applicants are to list down the activities involved in the current school. Please provide or attach photocopy of certificates as proof of participation (if available) in support of your scholarship application.

CSR Participated:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Sports:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Clubs:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Uniform Bodies:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Music Instruments:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Kingsley International SchoolKingsley House, 2, 12, 12A & 16, Jalan Putra Mahkota 7/8E, Putra Heights, 47650 Subang Jaya, Selangor

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kisKISB-FM-038

Rev.date: 7Feb2020

D. SCHOOL COMMUNITY INVOLVEMENT

Applicants are invited to list examples of their school community involvement using the list on the front page as a guideline regarding what to include.

Please provide or attach all photocopy of certificates as proof of participation.

Student’s Sign: _______________________ Parent’s Sign: __________________________

Date: _______________________ Date: _________________________________

D. PARTICIPATION IN SCHOOL ACTIVITIES & CSR

Applicants are to list down the activities involved in the current school. Please provide or attach photocopy of certificates as proof of participation (if available) in support of your scholarship application.

CSR Participated:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Sports:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Clubs:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Uniform Bodies:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Music Instruments:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

KISB-FM-124 (1) Rev.date: 19 Feb 2020

ACADEMIC STANDARDS

Applicant is required to provide details of the UPSR examination and school trial examination in the space below.

Applicants may highlight any significant academic success

Name of School: Year:

Address of school: _____________________________________________________________

UPSR Subjects and Results

01 06

02 07

03 08

04 09

05 10

Academic Awards / Other Qualifications

No Name of Examination/Award Grade/Award

01

02

03

04

05

Kingsley International School Persiaran Kingsley, Kingsley Hill, Putra Heights, 47650 Subang Jaya, Selangor.

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kis KISB-FM-038

Rev.date: 7Feb2020

HIGH SCHOOL SCHOLARSHIP APPLICATION FORM

INSTRUCTIONS1. Please fill up the application form in BLOCK LETTERS.2. Each applicant is allowed to submit only ONE application3. All fields in the form must be filled up and not left blank.4. Only shortlisted candidates will be notified for interview.5. Incomplete application forms that do not comply with the eligibility criteria WILL

NOT be considered.6. Please send the duly completed form with all the required supporting documents to

Kingsley Registrar Office.

A. STUDENT DATA

FULL NAME : ___________________________________________________________ (Write clearly in BLOCK LETTER)

GENDER : ____________________________________________________________

DATE OF BIRTH : ______________________ PLACE OF BIRTH : ___________________

NRIC NO : ______________________

Postal Address: _________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

State: _________________________________ Postcode: ___________________________

Telephone (resident): _____________________ Mobile No: _________________________

Email: ________________________________________________________________________

Current education level: ________________________________________________________

Level year to enroll in: ___________________

Passport sized photograph

No. Subject Grade No. Subject Grade

D. PARTICIPATION IN SCHOOL ACTIVITIES & CSR

Applicants are to list down the activities involved in the current school. Please provide or attach photocopy of certificates as proof of participation (if available) in support of your scholarship application.

CSR Participated:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________Sports:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________ Clubs / Music Instruments:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________ Uniform Bodies:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

D. PARTICIPATION IN SCHOOL ACTIVITIES & CSR

Applicants are to list down the activities involved in the current school. Please provide or attach photocopy of certificates as proof of participation (if available) in support of your scholarship application.

CSR Participated:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________Sports:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________ Clubs / Music Instruments:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________ Uniform Bodies:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Kingsley International School Persiaran Kingsley, Kingsley Hill, Putra Heights, 47650 Subang Jaya, Selangor.

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kis KISB-FM-124 (1)

Rev.date: 19 Feb 2020

E. DECLARATION

I, , I/C No.

father/mother/guardian of do hereby certify that all information provided in this application are true and accurate to the best of my knowledge and have not withheld any material information which might influence the consideration of this application.

I understand that KIS reserves the right to vary or reverse any decision regarding scholarship status made of the basis of incorrect or incomplete information.

_________________________________ Date: ______________________________ Parent’s sign

==================================================================== FOR OFFICE USE ONLY

General Observations & Comments

Application received by: ________________________________ Date: ________________________

Shortlisted Yes No

Scholarship Approved Yes No

Scholarship approved/rejected by: Date:

_______________________________________ _______________________________

Attitude & Character Grooming & Disposition

%

Kingsley International School Persiaran Kingsley, Kingsley Hill, Putra Heights, 47650 Subang Jaya, Selangor.

Tel +603-5191808 Fax +603-51919809 Email: enquiry@kingsley.edu.my Website: www.kingsley.edu.my/kis KISB-FM-124 (1)

Rev.date: 19 Feb 2020

F. PERSONAL ESSAY STATEMENT

Write an essay of about 150 words to highlight: 1 - your strengths and involvement in any school community activities. 2 – your take and belief in living in a healthy and safe community. This must be submitted along with your completed application.

(Please use separate sheets of papers if the column provided is not sufficient)

NAME: