MTSF
MTSF
MALAYSIA TORAY SCIENCE FOUNDATION
199301015077 (269817-K)
SCIENCE EDUCATION AWARD
|YYEAR : | |
APPLICATION FORM
Kindly read and comprehend the “Information” and “Online Submission Guide” before submission. The downloaded application form should be nicely typed/ printed/completed. Upon obtaining the necessary authority’s endorsement, scan the entire form/enclosures (in pdf file) for the mandatory submission online, via the MTSF Website on/before 31st May deadline. no hard copies are required to be sent to the Secretariat, in line with the Foundation’s Go-Green initiatives.
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|Title of Project |: | |
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| (Note : Title should describe the content briefly and accurately). Max. 25 words |
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|Area of Study : (please tick () |Subject (#) : (please tick () | | |
|Lower Secondary School | | Physics | | |
|Upper Secondary School | | Chemistry | | |
|Pre-University Colleges | | Biology | | |
|Others | | Others | | |
|(Please specify) ___________________ (Please specify) ___________________________ |
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|I hereby nominate _____________________________ as applicant for the Science Education Award. |
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|______________________________ _________________________ |
|Principal’s Signature & rubber stamp Date |
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|Name of Principal : ____________________________________________________ |
|(Head/Director) (please indicate title e.g. Dr./Mr./Ms. if applicable) |
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|Name of School/Institution : ______________________________________________________ |
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|Tel : _______________ Fax : _______________ Email : ______________________________ |
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|(#) Tick ( the appropriate area of study. If content covers more than two areas or is difficult to classify, mark the closest with an |
|asterisk (*). |
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|Note : Only forms nominated by the Principal are accepted. |
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|Particulars of Main Applicant : | |
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| |PHOTO |
| |(Compulsory) |
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|Full Name |: __________________________________________ | |
|(Please indicate title e.g. Dr./Mr./Ms. if applicable) | |
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|Name in Chinese character : _________________ Age : ___________ | |
|(if applicable) | |
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|NRIC No. : | | |
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|Place of Birth : | |
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|Nationality : |________________ |Gender : |Male | |Female ____________ |
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|Name & Address | |
|of School/ | |
|Institution : | |
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| |Tel : |Fax : |
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|Present Position : | |
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|Home Address : | |
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| |Tel : |Mobile : |
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|Email : | |
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|Final Education (date of graduation, name of school/faculty, department, major) and Job Experience : |
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|By submitting my/our application, I am certifying that : |
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|I have provided true, complete, accurate information in my/our application and related documents, and I have represented myself/ourselves,|
|my/our project and my/our accomplishments in a manner consistent with the norms of the relevant field. |
|As the named Applicant, I have ensured that others listed on the application have agreed to be included in the application. |
|The co-applicant(s) has/have agreed that the Applicant will administer the award on behalf of the group/team. |
|Consent has been obtained from all concerned individuals whose personal information is included in this application. |
|I have read, understood and agree to abide by the Personal Data Protection Policy of MTSF (the latest version of which is posted on its |
|website and a hardcopy available upon request). |
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|____________________________ _______________________ |
|Signature of Main Applicant Date |
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|Particulars of Co-Applicants : (limited to only 3 members) : |
|(Members of the group must be Malaysian teachers and/or educators) |
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|Full Name : | |
| (Please indicate title e.g. Dr./Mr./Ms. if applicable) |
|Name in Chinese |
|character (if applicable) : ____________ NRIC No : ___________________ Age : _______ |
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|Present Position : | |
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|Name & Address of School/Institution : |_______________________________________________________ |
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|Email : Tel : Fax : |
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|Full Name : | |
| (Please indicate title e.g. Dr./Mr./Ms. if applicable) |
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|Name in Chinese |
|Character (if applicable) : ___________ NRIC No : ___________________ Age : ________ |
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|Present Position : | |
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|Name & Address : |_________________________________________________________ |
|of School/ | |
|Institution | |
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|Email : Tel : Fax : |
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|Full Name : | |
| (Please indicate title, e.g. Dr./Mr./Ms. if applicable) |
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|Name in Chinese |
|Character (if applicable) : ____________ NRIC No : ___________________ Age : _______ |
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|Present Position : | |
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|Name & Address : |______________________________________________________ |
|of School/Institution | |
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|Email : Tel : Fax : |
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|Remarks : (Please tick ( the appropriate answer) |
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|Details of Project |
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|Topic / Syllabus : _______________________________________________________ |
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|Level (Form 1 to 6) : ______________________________________________________ |
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|Applicable to students in : ___________________________________________________ |
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|(B) Originality & Implementation |
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|I hereby certify that the above mentioned project : |
|(please ( tick) |
|(i) | |is my/our original creation. |
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| | |is an improvement from other existing project. |
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| | |Source : | |
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|(ii) | |has been implemented in the school. |
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| | |has yet to be implemented. |
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|(C) Other Award(s) |
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|Have you already received any other award or have made a presentation of the same |
|content elsewhere ? |
| | |Yes | |No. |
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|If Yes, indicate the most noteworthy : |
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|Date | | |
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|Venue | | |
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|Amount | | |
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|(D) Past MTSF Application(s) / Award(s) : |
| Have you applied for this MTSF Science Education Award before ? |
| | |Yes | |No. |
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|If Yes, applied ________ times, received award ________ times. |
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|List the year(s) awarded : |
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|Year |
|Category |
|Amount |
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|Year |
|Category |
|Amount |
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|(E) Patent : |
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|(Tick ( the appropriate answer) |
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|Patent No. |
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|Patent Application No. |
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|Intend to Patent |
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|Will not Patent |
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|Background and Purpose : |
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|Details of Content : |
|(Please use additional A4 paper, if necessary. Maximum of 4 additional pages only). |
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|Implementation of the Teaching/Guidance Methods, etc : |
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|Results and Benefits of Implementing the Teaching/Guidance Methods, etc : |
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Note: Due to space constraints, each applicant is allowed to submit a maximum of 20 pages (“Application Form” and “Enclosures”) online. Where necessary, other documents or attachments may be produced during the interview.
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