* We will contact you if a scholarship is available to you Nursing Scholarship Registration Full Name* (as in Identity Card)Alias/Other Name (if any) Passport Number Passport Expiry Date DD dash MM dash YYYY (dd-mm-yyyy) eg. 01-01-1999" IC Number*(781111031234)Date of Birth (dd-mm-yyyy) e.g. 01-01-1990* DD dash MM dash YYYY Gender* Male Female Dietary Requirement* Normal Halal Vegetarian Home Contact No. (include Country Code)*Address*Email* Next-of-Kin (NOK) InformationNOK Name* (NOK) Relationship*FatherMotherBrotherSisterGrandfatherGrandmotherUncleAuntieOthers(NOK) Contact No*(NOK) Email* SPM / UEC Grades Highest Qualification*SPMUECSTPMO-LevelPre-UniversityDiplomaDegreeYear of SPM/UEC obtained (Students taking SPM this year, kindly input 2019)* EnglishA+AA-B+BC+CDEGA1A2B3B4B5B6C7C8F9MathA+AA-B+BC+CDEGA1A2B3B4B5B6C7C8F9ScienceA+AA-B+BC+CDEGA1A2B3B4B5B6C7C8F9Science Subject Name*ScienceBiologyChemistryPhysics2 Other Best Subjects (Excluding Moral Education and Art)Best Subject 1 ScoreA+AA-B+BC+CDEGA1A2B3B4B5B6C7C8F9Best Subject 1 Name (in English)* Best Subject 2 ScoreA+AA-B+BC+CDEGA1A2B3B4B5B6C7C8F9Best Subject 2 Name (in English)* State of School/College where you obtained the above results*Kuala LumpurJohorKedahKelantanMelakaNegeri SembilanPahangPerakPerlisPulau PinangSabahSarawakSelangorTerengganuOthersConsent* I have read and agree to the website terms and conditionsYour personal data will be used to support your experience throughout this website, to manage access to your account, and for other purposes described in our privacy policy. I declare that the information provided by me on the above form is true and correct to the best of my knowledge and belief. HiddenUntitled