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  __________