Scholarship Application form

The 2nd International Conference on Corporate Social Responsibility 2004

(Equatorial Hotel in Penang, Malaysia November 21- 23, 2004)

Scholarship is available to the limited number of delegates who need financial support to attend the conference. The form must be returned and reached our office before 31st July 2004. Applicant will be notified of the results of the review process within a month after the deadline on 31st July 2004. Ansted Service Center, The Department of Social Responsibility Award, P O Box 1067, 10840 Penang. Malaysia. 

Personal details

Family/Surname/Last name:____________________________Givenname___________________________

Name to appear on Conference Badge with title : _____________________________________

Name of Organisation/Institution : __________________________________________________

Nature of business activities : _____________________________________________________

Position held/ Job Title : ________________________________ Department :_______________

Mailing address : _______________________________________________________________

Nationality :______________________ Sex : __________Age :__________Marital Status : ____

Please use full international telephone and fax numbers providing country code, area code, and number :

Telephone(office) : _______________(Home) : _______________(Mobile): ________ 

Fax(Office) : __________________________Email(s) : _________________________________

WWW address (company):_____________________________(personal) : _________________

Dietary restrictions (if any) : _______________________________________________________

Passport No. (Non-Malaysian need to fill in for immigration purpose) : ______________________

Please print my name as (onto the certificate of attendance) : ____________________________ 

 I would like to apply:

{   } Accommodation (   ) nights: Maximum 5 nights can be supported.

{   } Registration Fee waive

(   ) YES, I will recommend this conference to my network contacts whom can afford to pay and attend this conference too.

(Names_______________________________________________________________)

(Use separate sheet as needed)

  1. Explain below in detail your role at the conference:
  1. Please tell us about your achievements in career and social life:
  1. How will you use the experiences gained from the 1st & the 2nd CSR Conference when you return home?
  1. Have you attended Corporate Social Responsibility Conference before?
  1. Why do you want to participate this conference organized by Ansted University and its foundation?
  1. What are the benefits that you can bring to the Foundation and its conference?

 Note: No Air Ticket can be sponsored. Awardees of Ansted Social Responsibility International Award 2004 are not entitled for this scholarship.