MCKL TEACHING SCHOLARSHIP 2015 APPLICATION FORM

MCKL TEACHING SCHOLARSHIP
2015 APPLICATION FORM
A. APPLICANT INFORMATION (USE BLOCK LETTERS)
Name (as in MyKad):____________________________ MyKad No:_______________ Sex: M/ F
COURSE OF STUDY:  Mathematics
 English Literatures
 Physics
 Chemistry
 Early Childhood Studies
 Economics
 ___________
Home address:____________________________________________________________________
_____________________________________________ Postcode: _________________________
Home Tel:_____________________________________ Mobile Tel: _________________________
E-mail (compulsory):____________________________
B. ACADEMIC RESULTS (Attach certified true copy of the results slip.)
School name: ____________________________________________________________________
Tick one
SPM actual results
 GCE O-Levels actual results
Subject
Grade
Subject
Grade
Institution name:____________________________________________________________________
Tick one
 A-Level actual results
 AUSMAT
 Diploma actual results
Subject
Grade
Subject
Grade
C. EXTRA-CURRICULAR ACTIVITIES
(Involvement may be in school or non-school activities e.g. Boys’ Brigade, church, etc. Please attach
certified true copies of supporting documents)
No
Activities
School / Institution
Position
Year
D. FAMILY PARTICULARS
Father’s Name: _______________________________________ Age: _____________________
Address:
______________________________________ Tel (Hse): _________________
_______________________________________ HP No: ___________________
Occupation:
_______________________________________
Mother’s Name: _______________________________________Age: _____________________
Occupation:
_______________________________________ HP No:____________________
Gross annual household income: RM ______________________________________________
E. PARTICULARS OF SIBLINGS
No
Name
Gender
Age
Occupation
Name of Employer / School
F. PERSONAL OBJECTIVES
Write a short essay on your career aspiration and comment on your reasons for choosing teaching
as a career (use a separate sheet, if required).
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
G. DECLARATION
I declare that the information given is accurate and true. I authorise the College to verify the
information from whatsoever sources and by whatever means that deems appropriate.
I understand that this award may be withdrawn if it is found that I have not provided the correct
information. I have also read and agreed to the terms and conditions as specified below.
Signed by the applicant:_______________________________ Date:_________________
Name: _____________________________________________
MyKad No.: _________________________________________
H. SUBMISSION INSTRUCTIONS
1.
2.
Applications must be submitted to the Office of Registrar before 5.00pm on 22 May 2015.
Incomplete forms and unsupported statements will not be considered.
Terms and Conditions
1. Shortlisted applicants will be required to attend an interview. Notification of the date, time and
venue of the interview will be done via e-mail and SMS. Failure to respond to the email or SMS
by the prescribed deadline will result in the offer being withdrawn.
2. The recipient of the Scholarship is bonded to take up lecturing position in MCKL or serve as
secondary school teacher in any Wesley Methodist School in Malaysia.
3. The recipient is required to go through the Cambridge International Diploma in Teaching and
Learning (CIDTL) programme while serving at MCKL as lecturer.
4. The recipient of the Scholarship will have to sign an agreement with MCKL. The recipient will be
bonded for one and a half (1½) year for each year of sponsorship. However, the Scholarship
Panel reserves the right to review the length of the bond.
5. Recipients must not accept any other scholarship, financial aid or sponsorship from any
registered organization or university whereby they will be bonded while the agreement with
MCKL is still in force. Should they accept any non-binding scholarship, financial aid, award or
sponsorship from any registered organization or university, they are obliged to inform the
College in writing of the source and amount of the award within two (2) weeks of the award
date.
6. Recipient pursuing Bachelor degree in ECE will have to undergo six (6) months of industrial
attachment to gain experience while carrying half the normal teaching load in the ECS
department at the start of service with MCKL.
7. The amount of award and the number of full/partial scholarships to be given out are at the
discretion of the Management of MCKL.
8. This Scholarship is given at the sole discretion of the College. Applicants are not guaranteed
approval of the scholarships upon fulfilling the conditions set.
I. For office use
1. Received by
Office of the
Registrar
Action
Check form and
documentation
complete.
Shortlist
applicant.
Comments (if any)
Name and signature
Date
Inform applicant
through e-mail
and SMS.
2. Interview results
Interview date & time:
Approved Rejected. Reasons
Interview panel
Name and signature
Date
CEO
Institutional Director
Director of Academic Studies
Registrar
ACKNOWLEDGEMENT OF SUBMISSION
Name of applicant: ……………………………………………………………………………………………………….
COURSE OF STUDY:  Mathematics
 English Literatures
Date submitted:
Official stamp and signature:
 Physics
 Chemistry
 Early Childhood Studies
 Economics
 __________