You only need 3 CREDITS to apply to ALL Diploma Programmes
(Anda perlukan hanya 3 KREDIT untuk memohon SEMUA Program Diploma)
 
 
 
ENROLMENT TO UNDERGRADUATE PROGRAMS
 
 
 
 
Date: 09 Feb 2010 13:42 PM
  
 
 
 
 
 
 
     
  CHOICE OF COURSES PREFERRED  
     
 
* 1st Choice
* 2nd Choice
* 3rd Choice
   
 
  PERSONAL DETAILS  
     
 
* Name
* Postal Address
 
* Postcode * City
* State
* Country
 
     
 
Identification Card (I.C) Details
* New NRIC Old NRIC
       
* Date of Birth
* Nationality
* Race * Religion
* Gender MALE      FEMALE
* Marital Status
       
 
  * Telephone Information (At least 1 phone number must be entered)  
 
Home
Handphone
Email
 
     
 
* Permanent Address Copy from 'Postal Address'.
 
* Postcode * City
* State
* Country
 
 
Telephone No.    
Handphone No.    
 
     
  Particular of Parents (Mother/Father/Guardian)  
 
*Name
*Correspondence Address
 
*Postcode *City
*State
*Country
Phone Number
Office Number
Fax Number
 
 
  Emergency Contact (If different from above)  
 
Name
Correspondence Address
 
Postcode City
State
Country
Phone Number
Office Number
Fax Number
 
 
 
  EDUCATION BACKGROUND (The University reserves the right to withdraw the OFFER if any information given is found to be false or misleading or if entry requirements are not met)  
     
  SPM / SPMV / O-Level  
     
 
* Certificate Type
* Year
Stream(science/art)
* School
* Institution Name
* Grade
 
     
 
No Subject Grade
1 Bahasa Malaysia
2 Matematik
3 Bahasa Inggeris
4
5
6
7
8
9
10
11
 
     
  STPM / STP / HSC / A-Level ( if applicable)  
     
 
Certificate Type
Year
Stream (science/art)
School
Institution Name
Grade
No Subject Grade
1
2
3
4
5
 
     
  DIPLOMA ( if applicable)  
 
 
Date of completion
Course Name
College/University
Institution Name
Grade / CGPA
LAN / MQA Accreditation Status (* Madatory if IPTS - Please check your MQA status at http://www.mqa.gov.my)
   
 
MATRICULATION / FOUNDATION / PRE-U (if applicable)
 
Certificate Type
Date of completion
Course Name
College/University
Institution Name
Institution Address
Postcode
State
Country
Grade / CGPA
LAN / MQA Accreditation Status (* Madatory if IPTS - Please check your MQA status at http://www.mqa.gov.my)
 
 
  DIPLOMA / MATRICULATION / FOUNDATION / PRE-U (If you have an Engineering Diploma/Matriculation/Foundation/Pre-u please enter your individual physic and math subject and grade)
 
  Mathematic Grade     Physic Grade
1   1
2   2
3   3
4   4
5   5
 
  CERTIFICATE (if applicable)
 
 
Date of completion
Course Name
College
Institution Name
Grade / CGPA
LAN / MQA Accreditation Status (* Madatory if IPTS - Please check your MQA status at http://www.mqa.gov.my)
   
MUET  
Please enter year MUET taken (year only)
Band (MUET Grade only)
   
  FINANCIAL SUPPORT
 
i) Be Supporting yourself? YES         NO
ii) Be Supported by your employer? YES         NO
iii) Be Supported by any other sponsor? YES         NO
If YES , please specify :
 
     
  HEALTH INFORMATION  
 
Do you EVER diagnose of having any critical disease? YES         NO
If YES , please specify :
Are you physically disabled? YES         NO
If YES , please specify :
*Are you color blind?
 
 
  GENERAL  
 
Have you ever been convicted of criminal offense? YES         NO
If YES , please specify :
Have you ever been committed for discipline charge? YES         NO
If YES , please specify :
 
     
  DECLARATION  
 

I certify that the information that I have given in this aplication form is correct. I agree to the condition that the University has the right to reject this application to withdraw the offer of admission or so to terminate my study if any information given is found to be incorrect. I also undertake to observe and ensure payment of all fees and other liabilities are made on time

 
 
 
* Name
Date 09 Feb 2010 13:42 PM