Lear N Fund Application Form: Personal Details of Applicant

LEAr N FUND APPLICATION FORM
PERSONAL DETAILS OF APPLICANT * Please fill up all details in BLOCK letters or circle if applicable. Name (Eng): NRIC No.: Date of Birth: Permanent Address: ____ (dd)/ ____ (mm)/ _______ (yy) Gender: F / M Nationality: (Chinese): Age:
Recent Passport Size Photograph
Tel. No.:
Correspondence
H/P:
Others:
Address:
(If different from the above)
Email Address: Highest Academic Qualication Obtained: Extra-Curricular Activities (Organisation/Position): 1) 2) 3) Awards Obtained (Academic or Extra-Curricular Activities): 1) 2) 3) Name of Institution of Higher Learning: Name of Course: Course Duration (Total No. of years): Current Year of Study in Course (eg. 1st year, 2nd year): Total Course Fees per year:
Expected Course Completion:
(mm)
(yy)
RM
If you have applied for other scholarships or loans, please state scholarship name(s): 1) 2) If you have received other scholarships or loans, please state scholarship name(s) & amount(s): RM RM I hereby certify that all the information provided above is true and correct. Applicant's Signature: Date:
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PERSONAL DETAILS OF GUARANTORS (1) Guarantor's Name (Eng): NRIC No.: Gender: Occupation: Home Address: F / M (Chinese): Date of Birth: ___ (dd)/ ____ (mm)_______ (yy) Relationship to Applicant: Monthly Income:
RM
Tel. No.:
H/P:
Email:
Employer's or Company's Name & Address:
Tel. No.:
Fax No.:
I hereby certify that all the information provided above is true and correct. Guarantor's Signature: PERSONAL DETAILS OF GUARANTORS (2) Guarantor's Name (Eng): NRIC No.: Gender: Occupation: Home Address: F / M (Chinese): Date of Birth: ___ (dd)/ ____ (mm)_______ (yy) Relationship to Applicant: Monthly Income: Date:
RM
Tel. No.:
H/P:
Email:
Employer's or Company's Name & Address:
Tel. No.:
Fax No.:
I hereby certify that all the information provided above is true and correct. Guarantor's Signature: Date:
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FAMILY BACKGROUND OF APPLICANT 1 Father/Guardian Name: (Eng) NRIC No.: Occupation: 2 Mother/Guardian Name: (Eng) NRIC No.: Occupation: 3 Siblings No. of Siblings: Name No. of siblings in full-time education: Name of School / College / University Age (Chinese): Date of Birth: ____ (dd)/ _____ (mm)/ _______(yy) Monthly Income: (Chinese): Date of Birth: ____ (dd)/ _____ (mm)/ _______(yy) Monthly Income:
RM
RM
No. of siblings under employment: Name Occupation RM RM RM RM RM I hereby certify that all the information provided above is true and correct. Applicant's Signature: Date: Monthly Income
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Please state briefly your main reasons for applying LEAr N Fund study aid:
Referred by Lions Club of
______________________________
President's Signature: President's Name: _______________________________ Date:
Secretary's Signature: Secretary's Name: ___________________________ Date:
_______________________________
___________________________
APPLICATION PROCEDURE
a)AllapplicantsmustfillintheofficialapplicationformsofLEAr N Fund and affix a non-returnable latest passport size photograph. Completed forms should be returned to: LEAr N Fund Selection Department. Lions Selection Committee B-10-5, Block B, Megan Avenue 1, 189 Jalan Tun Razak, 50400 Kuala Lumpur. b)Incompleteformswillnotbeentertained. c) Applicants must enclose certified copies of the following documents: * SPM or STPM examination results * SPM or STPM preliminary examination results * School Testimonial and School Leaving Certificates * All other certificates stated in the application form * Identity Card * Offer Letter from the Higher Education Institution stating the course name, course structure and fee structure * EPF statement, income tax statement or any other proof of income of parents/guardians and/or siblings * Two guarantors are required for this application * One of the guarantors must be the parent/guardian of the applicant * A copy of the identity card of the guarantor must be provided * The guarantor must not be a bankrupt or undergoing bankruptcy proceedings
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DEFINITION
LEAr N Fund: Lions Education Assistance for the Needy Fund. Lions Selection Committee: The committee members appointed to carry out the interview session/s with the applicants and to decide on their eligibility and the study aid value. LEAr N Fund Agreement: An official agreement between the applicant and Lions Education Foundation with all the terms and conditions stated therein. Study Aid: Amount granted to the applicant by the LEAr N Fund.
1. APPLICANT'S ELIGIBILITY
1.1. The Applicant must be a Malaysian pursuing full time higher education and gained admission into any private or public Institutions of higher learning (colleges or universities) in any academic disciplines in Malaysia excluding drama, singing artists, beauty and the like. 1.2.TheInstitutionofhigherlearningmustberecognizedbytheMinistryofEducationofMalaysia. 1.3.TheApplicantmustpossessconsistentandsatisfactoryacademicrecordsand/oractiveparticipationin extracurricular activities in school. 1.4.TheApplicantmustnotbeolderthan20yearsforDiplomaprogrammesandnotolderthan25yearsforDegree programmes. 1.5.ThecombinedincomeoftheparentsmustnotexceedRM30,000perannum.
2. APPLICANT'S OBLIGATIONS
2.1.TheApplicantmustberecommendedorreferredbyanyoftheLionsClubsinMalaysia. 2.2.TheApplicantmustattendaninterviewsessionconductedbytheLionSelectionCommitteeandagreedthatthe decisions made by the said committee are final and shall not be challenged. 2.3.SuccessfulApplicantshallbeboundbythetermsandconditionssetoutintheLEAr N Fund Agreement.
3. STUDY AID COVERAGE

3.1.ThestudyaidisRinggitMalaysiaFiveThousand(RM5,000)perannumonly. 3.2.TheApplicantshallbeboundbythestudyaidrepaymentschedulesetoutintheLEAr N Fund Agreement unless he/she secured a minimun CGPA3.80 and above for each and every semester term. 3.3. The life of the applicant shall be insured by Lions Education Foundation covering the study aid.
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LEAr N FUND APPLICATION FORM

Recent Passport Size Photograph