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Pusat Pengajian Pascasiswazah Centre for Postgraduate Studies UNIVERSITI MALAYSIA SABAH

BORANG PERMOHONAN SKIM BANTUAN PASCASISWAZAH UMS UMS POSTGRADUATE ASSISTANCE SCHEME APPLICATION FORM

Sila tandakan () pada skim pilihan:- Please mark () on selected scheme:-

Skim Yuran Pengajian Tempatan (SYPT) UMS UMS Local Tuition Fee Scheme

Skim Yuran Pengajian Antarabangsa (SYPA) UMS UMS International Tuition Fee Scheme

Hanya boleh memilih satu skim sahaja. Only one scheme can be selected.

A. MAKLUMAT PEMOHON PARTICULAR OF APPLICANT 1. No. Pelajar Student No.

-

2. Nama Penuh (mengikut Kad Pengenalan/Pasport) Full Name (as per Identification Card/Passport)

3. No. Kad Pengenalan/Pasport Identification Card /Passport No.

4. Tarikh Lahir (HH-BB-TTTT) Birth of Date (DD-MMM-YYYY)

- -

5. Umur Age

6. Jantina Gender

Lelaki Male Perempuan Female

7. Bangsa & Status Perkahwinan / Marital Status & Race

8. Warganegara Citizen

9. Alamat surat-menyurat Correspondence Address

10. No. yang boleh dihubungi Contact No.

No. Telefon Bimbit Mobile phone no.

No. Telefon Rumah House Phone No.

No. Telefon Pejabat Office Phone No.

11. E-mel E-mail

B. MAKLUMAT PENGAJIAN PARTICULARS OF STUDIES

1. Peringkat Pengajian Level of study

Doktor Falsafah Doctor of Philosophy Sarjana Falsafah Master of Philosophy Sarjana Master

2. Bidang Pengajian Field of Studies

3. Tajuk Penyelidikan [Sila lampirkan rancangan penyelidikan yang akan dirujuk sebagai Lampiran A] Research Title [Please submit a research proposal as Attachment A]

4. Nama Penyelia Name of Supervisor

Sila lekatkan gambar berukuran

passport

Please affix passport size photo

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5. Berapa lama pemohon mengenali Penyelia? How long have you known your Supervisor?

Bulan Month Tahun Year

C. MAKLUMAT PEMOHON YANG TELAH MEMULAKAN KERJA PENYELIDIKAN INFORMATION REGARDING APPLICANT WITH ON-GOING RESEARCH

1. Sejak bila penyelidikan bermula? (HH-BBB-TTTT) - -

Since when your research began? (DD-MMM-YYYY)

2. Peratus siap penyelidikan dijalankan %

Percentage of research completion

3. Tempoh diperlukan untuk menyiapkan penyelidikan Bulan Tahun

Period need to complete the research Month/s Year/s

4. Tangguh Pengajian Deferment of Studies Ya Yes Tidak No

Jika Ya, bila? If yes, when?

Semester Semester Sesi Session -

5. Adakah anda sedang menerima sebarang pendapatan/bantuan kewangan semasa menjalankan penyelidikan? (Contohnya : Bekerja sebagai Pembantu Penyelidik/Jururunding/Penerima Skim Bantuan/Biasiswa dll.) Did you receive any other income/financial aid while conducting your research? (E.g Worked as Research Assistant (RA)/Consultant/under other Assistance Scheme/Scholarship etc.)

Ya Yes Tidak No

Jika Ada, If Yes, please specify

5.1 Sila nyatakan jenis pekerjaan/bantuan yang diterima Please specify type of work/assistance received ____________________________________________________________________________________________________ 5.2 Tempoh pekerjaan/bantuan Duration of work/assistance

Bulan Month Tahun Year

5.3 Tarikh mula kerja/bantuan (HH-BBB-TTTT) Date start working/assistance (DD-MMM-YYYY)

5.4 Tarikh tamat kerja/bantuan (HH-BBB-TTTT) Date of expire working/assistance (DD-MMM-YYYY)

- - - -

D. MAKLUMAT AKADEMIK ACADEMIC INFORMATION 1. Sijil Mengengah (SPM/SPMV), Pra-Universiti (STPM, Pra-Universiti/Matrikulasi/A-Level/Diploma) Secondary Certificate (SPM/SPMV), Pre-University (STPM, Pre-University/Matriculation/A-Level/Diploma)

Sekolah/Kolej School/College

Sijil Certificate

Tahun Peperiksaan Year of Examination

Keputusan Peperiksaan Result of Examination

2. Peringkat Sarjana Muda (Sila kemukakan salinan Skrol & Transkrip Keputusan Peperiksaan yang telah disahkan) Bachelor Degree Level (Please enclosed a copy of duly certified of Scroll & Examination Transcript)

a. Nama Ijazah & Bidang Pengajian Name of Degree & Field of study _________________________________________________________________________________________________

b. Nama Universiti Name of University _________________________________________________________________________________________________ c. Tahun Bergraduat Year of graduation

d. Kelas Ijazah/PNGK Class of Degree/CGPA ___________________________________________________________ e. Jenis penajaan Type of Sponsorship

Pinjaman Loan Biasiswa Scholarship Sendiri Self Finance

f. Name pinjaman/biasiswa Name of loan/scholarship _________________________________________________________________________________________________

g. Tempoh pinjaman/biasiswa Duration of loan/scholarship

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Bulan Month Tahun Year

3. Peringkat Ijazah Sarjana (bagi Pemohon Doktor Falsafah) (Sila kemukakan salinan Skrol & Transkrip Keputusan Peperiksaan yang telah disahkan) Master Degree Level (for Doctor of Philosophy applicant only) (Please enclosed a copy of duly certified of Scroll & Examination Transcript)

a. Nama Ijazah & Bidang Pengajian Name of Degree & Field of study

_________________________________________________________________________________________________

b. Nama Universiti Name of University _________________________________________________________________________________________________ c. Tahun Bergraduat Year of graduation

d. Kelas Ijazah/PNGK (Program Secara Kerja Kursus) Class of Degree/CGPA (By Coursework programme) _________________________________________________________________________________________ e. Nama Penyelia (Program Secara Penyelidikan) Name of Supervisor (By Research programme) _________________________________________________________________________________________ f. Jenis penajaan Type of Sponsorship

Pinjaman Loan Biasiswa Scholarship Sendiri Self Finance

g. Name pinjaman/biasiswa Name of loan/scholarship

_________________________________________________________________________________________________

h. Tempoh pinjaman/biasiswa Duration of loan/scholarship

Bulan Month Tahun Year

NO. No.

SENARAI PENULISAN & PENERBITAN JURNAL (ARTIKEL DALAM JURNAL/TESIS) List of Publication (Article in Journals/Thesis)

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E. KEGIATAN KO-KURIKULUM DAN ANUGERAH KHAS CO-CURRICULUM ACTIVITIES AND SPECIAL AWARDS 1. Sebarang pencapaian cemerlang dalam sukan/persatuan/kebolehan khas (Bahasa, Muzik dsbgnya) & Anugerah Khas. Any outstanding achievements in sports/clubs/special talent (Language, Music etc) and special awards.

NO. Pencapaian

Achievements Tahun Year

F. MAKLUMAT IBUBAPA/PENJAGA PARENTS/GUARDIAN INFORMATION 1. Nama Ibubapa/Penjaga Name of Parents/Guardian _____________________________________________________________________________________________________ 2. No. Kad Pengenalan/Pasport Identification/Passport No. _____________________________________________________________________________________________________ 3. Pekerjaan Occupation _____________________________________________________________________________________________________ 4. Alamat surat-menyurat Correspondence address _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 5. Pendapatan Kasar sebulan (RM) Gross Income per month (RM) _____________________________________________________________________________________________________ G. PENGALAMAN BEKERJA WORKING EXPERIENCE

Jawatan Post

Tarikh/Tempoh Date/Period

Alamat Majikan Employer’s Address

H. PENGAKUAN DECLARATION Saya dengan sesungguhnya mengaku bahawa segala maklumat yang diberi adalah benar. Jika didapati maklumat yang diberikan adalah palsu, pihak universiti berhak membatalkan sebarang tajaan yang ditawarkan. I do hereby declare that all information given have are true. If the information given here is falsified, University has the right to cancel the scholarship offer. Nama Name ____________________________________________________________ Tandatangan Signature ____________________________________________________________ Tarikh Date ____________________________________________________________

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I. LAPORAN PENYELIA (SULIT) SUPERVISOR’S REPORT (CONFIDENTIAL) Arahan Instruction: Laporan ini hendaklah dilengkapkan oleh Penyelia Pemohon dan dihantar secara berasingan ke Pusat Pengajian Pascasiswazah. This report must be completed by the Applicant’s Supervisor and must be sent separately with Application by the Supervisor to the Centre for Postgraduate Studies. Bahagian (i) Part (i) 1. Nama pelajar Student’s Name ______________________________________________________________________________________________________ 2. Tajuk Penyelidikan Research Title ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Bahagian (ii) Part (ii) 1. Nama Penyelia Supervisor’s Name________________________________________________________________________________________ 2. Alamat Jabatan Department’s Address ____________________________________________________________________________________ _______________________________________________________________________________________________________ 3. No. Telefon 4. E-mel Telephone No. ____________________________ E-mail ______________________________________________________ 5. Nama Jawatan Post Title __________________________________________________________________________________________ 6. Taraf Jawatan Tetap Sementara Kontrak Pinjaman Post Status Permanent Temporary Contract Loan atau lain-lain (sila nyatakan) or others (please State) _________________________________________________________________________________ Bahagian (iii) Part (iii) 1. Adakah anda berpuas hati dengan cadangan penyelidikan yang dikemukakan oleh pemohon? Are you satiesfied with the applicant’s research proposal? _______________________________________________________________________________________________________ 2. Nyatakan kekerapan pemohon berjumpa/berbincang dengan anda berhubung dengan kerja penyelidikannya? How often does the applicant meet and discuss his/her research work with you? _______________________________________________________________________________________________________ 3. Pada pendapat anda, apakah pemohon berkelayakan dan mampu menjalankan penyelidikan seperti yang dikemukakan

dalam permohonan ini? Do you feel that the applicant is qualified and capable to execute his/her research as proposed in this application? _______________________________________________________________________________________________________

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4. Adakah kemudahan/peralatan bagi menjalankan penyelidikan ini mencukupi? Jika tidak, sila nyatakan alternatif lain atau usaha yang sedang dibuat bagi mengatasi kekurangan tersebut? Are the facilities and equipments sufficient in order to conduct the research? If not, please state if there are alternatives or

efforts to overcome such problem? _______________________________________________________________________________________________________ 5. Apakah masalah yang dijangka akan dihadapi oleh pelajar semasa menjalankan penyelidikan ini ? Jika ada. What are the expected problems that the student will face while conducting the research? If any. _______________________________________________________________________________________________________ 6. Sekiranya pemohon telah memulakan penyelidikan, adakah pemohon mendapat sebarang pembiayaan? (Misalnya bekerja

sebagai RA, Biasiswa Pascasiswazah, syarikat swasta) If the applicant has already started the research, is he/she financially supported? (E.g Working as RA, Postgraduate Scholarship or Public sector) _______________________________________________________________________________________________________ 7. Adakah anda berkemungkinan akan bersara/cuti sabatikal/berpindah universiti/tamat kontrak semasa tempoh penyeliaan

pemohon ini? Is there any possibilities that you will retire/take sabbatical leave/change university/contract expire while supervising the

applicant? _______________________________________________________________________________________________________ 8. Nyatakan bilangan terkini pelajar dan penyelidik yang terlibat dalam penyeliaan anda (anda sebagai Penyelia Utama dan

Penyelia Kedua) Please state the number of students and researchers involved in your CURRENT supervision (you as Main Supervisor and Co-supervisor)

Kategori Penyeliaan Supervision

Category

Sarjana Master

PhD Doctoral

Penyelidik Post Doktoral

Post Doctoral Researcher

Pg. Penyelidik/Pem. Penyelidik (RO/RA)

Research Off./Research Ass. (RO/RA)

Pembantu Penyelidik Graduat(GRA)

Graduate Research Assistant (GRA)

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9. Sila nyatakan geran yang diterima oleh Penyelia-Penyelia berkaitan dengan penyelidikan pelajar. Please state the grant(s) received by Supervisor(s) which is related to the student’s research.

Tajuk Penyelidikan Geran & No. Projek

Research Grant’s Title & Project No.

Tarikh Mula dan Tamat

Geran Grant Start and End Date

Jumlah Geran & Baki Geran

Tahun Semasa (RM) Grant’s amount / Current

Balance of Grant (RM)

10. Sekiranya Penyelia-Penyelia tidak mempunyai geran R&D/masih dalm proses memohon geran/hanya mempunyai geran

yang peruntukan yang hampir tamat, sila nyatakan bagaimana keperluan geran yang mencukupi dapat disediakan kepada pelajar untuk membolehkannya menjalankan penyelidikan yang berterusan. (Contoh : Sila nyatakan tarikh dijangka kelulusan geran atau lain-lain alternatif) If Supervisor(s) does not have R&D Grants/ in the process to apply grants/only have grants that are almost finished, please state how a sufficient fund can be established in orderstudent can carry out the research. (E.g Please state the expected date of grant’s approval or other alternatives)

______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Pengakuan Declaration Saya mengaku semua maklumat yang diberikan seperti di atas adalah benar. I, hereby declare that all the given information stated here are true. Tandatangan Tarikh Signature _________________________________ Date ________________________________ Cop Rasmi Nama & Jawatan Official Name Stamp & Post

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SENARAI SEMAK PERMOHONAN SKIM BANTUAN PASCASISWAZAH CHECKLIST FOR UMS POSTGRADUATE ASSISTANCE SCHEME APPLICATION

Pemohon adalah dikehendaki menghantar 2 set dokumen-dokumen berikut:- Applicants are required to submit 2 sets of the following documents:-

NO. WARGANEGARA MALAYSIA

Malaysian Citizen

BUKAN WARGANEGARA MALAYSIA Non Malaysian Citizen

1. Borang asal Borang Permohonan Skim Bantuan Pascasiswazah. Original form of Application form for UMS Postgraduate Assistance Scheme.

Borang asal Borang Permohonan Skim Bantuan Pascasiswazah. Original form of Application form for UMS Postgraduate Assistance Scheme.

2. Rancangan Penyelidikan yang telah disahkan oleh Penyelia. A duly certified by the Supervisor of Research Proposal.

Rancangan Penyelidikan yang telah disahkan oleh Penyelia. A duly certified by the Supervisor of Research Proposal.

4. Salinan Kad Pengenalan dan Surat Lahir yang telah disahkan oleh Jabatan Pendaftaran Negara. A duly certified true copy of Identification Card & Birth Certificate by the National Registration Department.

Salinan pasport yang telah disahkan benar oleh Penyelia. A duly certified true copy by the Supervisor of passport.

5. Salinan sijil Akademik (Skrol & Trankrip Ijazah Sarjana, Skrol & Trankrip Ijazah Sarjana Muda, Pra-Universiti (Matrikulasi/Diploma/STPM) dan Sijil Menengah (SPM) yang telah disahkan benar oleh Penyelia. A duly certified true copy by the Supervisor of the Academic certificates (Scroll & Transcript for Master Degree, Scroll & Transcript for Bachelor Degree, Pre-University (Matriculation/Diploma/STPM), Secondary Level.

Salinan sijil Akademik (Skrol & Trankrip Ijazah Sarjana, Skrol & Trankrip Ijazah Sarjana Muda, Pra-Universiti (Matrikulasi/Diploma/STPM) dan Sijil Menengah (SPM) yang telah disahkan benar oleh Penyelia. A duly certified true copy by the Supervisor of the Academic certificates (Scroll & Transcript for Master Degree, Scroll & Transcript for Bachelor Degree, Pre-University (Matriculation/Diploma/STPM), Secondary Level.

6. Salinan Surat Tawaran Pengajian yang telah disahkan benar oleh Penyelia. A duly certified true copy by the Supervisor of the Offer Letter to pursue study at UMS.

Salinan Surat Tawaran Pengajian yang telah disahkan benar oleh Penyelia. A duly certified true copy by the Supervisor of the Offer Letter to pursue study at UMS.

7. Salinan sijil ko-kurikulum / anugerah khas yang telah disahkan benar oleh Penyelia. A duly certified true copy by the Supervisor of the Co-curiculum / special award certificate.

Salinan sijil ko-kurikulum / anugerah khas yang telah disahkan benar oleh Penyelia. A duly certified true copy by the Supervisor of the Co-curiculum / special award certificate.

Permohonan dihantar ke:- Application submitted to:-

Pusat Pengajian Pascasiswazah Universiti Malaysia Sabah Jalan UMS, 88400 Kota Kinabalu, Sabah Centre for Postgraduate Studies Universiti Malaysia Sabah Jalan UMS, 88400 Kota Kinabalu, Sabah PERMOHONAN YANG TIDAK LENGKAP TIDAK AKAN DIPROSES. INCOMPLETE APPLICATION WILL NOT BE PROCESSED.