2015 Sunflower Mission Engineering & Technology Scholarship

Application Form Thank you for applying to the 2015 Sunflower Mission Engineering &Technology Scholarship program. Please complete ALL sections. If you are completing the form by hand, please write clearly using a blue or black pen. The application deadline is 16 October 2015. For more information, please visit the scholarship web page. 1. Personal Information 2. Educational Background Please list briefly in chronologic order and provide a copy of your latest official transcript with this application form In academic year 2015-2016, I am due to complete year ______ Academic Results Name of university Major (nganh) Academic year (1/2/3/4/5) GPA score

Faculty (khoa) □ Electrical and Electronics □ IT/Computer Science □ Electronics □ Electronics & Telecommunication □ Other, please specify: …………………………………………………………

Other Courses/Qualifications/Training (Optional)

Courses From/to (mm/yy) Qualifications/certificates awarded

Gender: □ Male □ Female

Full name:

Date of birth (dd/mm/yyyy):

Home address:

Vietnamese ID number:

Contact phone number: Cell phone number: Email address:

Your most recent photo (3”x4”)

3. Employment History Please list briefly, in chronological order, any full- or part-time employment, if applicable Employer name From/to (mm/yy) Position held

4. Special Achievements, Honors and Recognition for Helping Others in the Community List and describe all awards, competition wins, honors, achievements and recognition you have achieved

I confirm that the information provided in this application is true and accurate. Applicant’s signature (please type your name if you are applying electronically) Date (dd/mm/yyyy): _____________________________________________ ______________________ Application package checklist: • Application form with 3x4 photo • Maximum 500-word essay in English; essay questions are available on the scholarship web page. • Official transcript of latest full academic year, GPA score of 7.0 or above • Other certificates/qualifications or recommendation letter(s) from your professor(s) will be an advantage, but are not

mandatory Application packages, including your application and all supporting documents, can be sent to the Assessment Committee by email or post:

• Via email to sm.et@esilicon.com or • By post to the appropriate office:

eSilicon Vietnam HCMC Unit 9.7, 9th Floor, eTown 2 364 Cong Hoa Street Tan Binh District, Ho Chi Minh City Attn: E&T Scholarship Assessment Committee

eSilicon Vietnam Danang 8th Floor, PVFC Building A2.1 Slot, 30/4 Street, Hai Chau District Danang City Attn: E&T Scholarship Assessment Committee

APPLICATION DEADLINE is 16 October 2015

All information provided will be treated as confidential