Merdeka Scholarships

Closing Date : 22 January 2016

Note:
1. Sections marked *** must be completed
2. Please use UPPER CASE LETTERS unless stated otherwise
3. Please attach the following documents:
a. A signed personal statement of not more than 1,000 words that includes:
- A description of the intended area of study;
- How this will benefit Malaysia;
- Reasons for wanting to study in Oxford;
- The personal qualities that make you a worthy recipient of a scholarship;|
b. A list of academic qualifications and other awards and honours received
c. A copy of the document showing the status of your application to the University of Oxford
d. Two confidential letters of recommendation from referees who can assess the applicants academic performance

A. DEGREE APPLIED FOR ***

(Note: All applicants should apply to the University of Oxford. This Section refers to the candidates separate application to the University of Oxford)

Degree Masters DPhil

Course Name and Code

Department
[Insert Your Photo Here]
Status of Application for Admission to the University of Oxford:

a) Date of Application

b) Status of Application Pending

Offered a conditional offer

Offered an unconditional offer

B. PERSONAL PARTICULARS ***

(Note: All applicants should apply to the University of Oxford. This Section refers to the candidates separate application to the University of Oxford)

Full Name

IC No (New)

Place of Birth

Date of Birth

Permanent address Postcode

Town

State
Country
(If outside Malaysia only)

1
 Mailing address Postcode

Town

State
Country
(If outside Malaysia only)

Telephone Mobile Email

(Use upper or lower case as per actual address)
Home

Marital Status Number of Children

C. QUALIFICATIONS ***

i - Professional qualification attained

Professional body

State Country

Discipline

Year (From) Year (Completed)

Parts Completed All Part Highest part completed

ii - Masters Degree

Institution / University

State Country

Discipline

Year (From) Year (Completed)

CGPA / Grade

ii - First Degree

Institution / University

State Country

Discipline

Year (From) Year (Completed)

CGPA / Grade Point / Class

2
 ii - Diploma

Institution / University

State Country

Discipline

Year (From) Year (Completed)

CGPA / Grade

D. VOLUNTARY ACTIVITIES (Attach a full description if necessary)

i - Society / Club

No Society / Club Position / Role Assumed Year

1

ii - Sports / Games

No Sports / Games Represented Year

1

iii - Awards / Commendations (Name main awards)

No Awards / Commendations received Level Year

1

3
E. EMPLOYMENT (If Relevant)
Please provide details of current / last employment, if any :

Are you currently employed ? Yes No

Current / Last Employer Address

Number of years with current/last employer

Position in company

Last drawn monthly salary RM

F. REFEREES ***
Please give details of the two referees who have written letters of recommendation on your behalf.

Referee 1

Name

Address

Position

Email address
(Use upper or lower case as per actual address)

Referee 2

Name

Address

Position

Email address
(Use upper or lower case as per actual address)

4
F. DECLARATION ***
I consent to the collection, processing, sharing and use of relevant personal data by the Centre for the purposes of processing my
application for study, for administration and (where applicable) for funding purposes, subject to the provisions of the Data Protection
Act 1998.

I understand that such personal data may be used and shared with third parties, some of which may be located overseas (including
outside the European Economic Area), for the purposes of verifying my identity, qualifications, work experience, references and any
submitted work. Where I apply for funding through the University, my personal data may be shared with third parties relevant to that
funding application.

I understand that the Centre will normally only discuss my application with me, unless I have nominated a third-party agent on my
application form.

I understand that if any information or statement provided on or to support this application form is not true, accurate, current and
complete, or any supporting material is not entirely my own original work, except where clearly stated otherwise, the Centre may
process and use this fact as relevant personal data. Such data may be used and shared with third parties, including Higher Education
institutions, some of which may be located overseas (including outside the European Economic Area), to the extent necessary for the
purpose of preventing fraudulent or dishonest applications for study, funding and/or visas.

I understand that if I become a registered student, any personal data collected by the Centre as a result of my application will form part
of my student record.

Name

Date