Student Application

  • Picture *Passport size :


  • A. Personal Data


    1. Full Name (As in international passport) :
    2. Date Of Birth : 

    3. Age :
    4. Nationality :
    5. Sex :
      Male Female
    6. Marital Status :
      Single Married
    7. Religion :
      (Please specify)
    8. Others :
      (Please specify)
    9. Passport No. :
    10. Date Of Expiry : 

    11. Date Of Issue :   

    12. Place Of Issue :
    13. Address :
    14. Tel No. (H) :
    15. Tel No. (M) :
    16. Tel No. (F) :
    17. Email :
        

    B. Current Location


    1. At home country / outside Malaysia :
      Yes No
    2. Already in Malaysia :
      Yes No
    3. Date of arrival :
    4. Type of visa/pass :
    5. Address in Malaysia :
      (Please fill in the address and Tel No. if already in Malaysia)
    6. Tel No. :
    7. Mobile No. :
    8. Fax No. :
        

    C. Educational Background

    (List in order of time, starting with the last institution attended)

    1. Name of Institution and Country* :
    2. Major Field of Study* :
    3. Year Attended (from - to)* :
      Eg: 2011-2013
    4. Qualification Obtained* :
      
    1. Name of Institution and Country :
    2. Major Field of Study :
    3. Year Attended (from - to) :
      Eg: 2011-2013
    4. Qualification Obtained :
      
    1. Name of Institution and Country :
    2. Major Field of Study :
    3. Year Attended (from - to) :
      Eg: 2011-2013
    4. Qualification Obtained :
        

    D. Language Proficiency


    1. English

    1. Listening :
      Excellent  
      Good  
      Fair  
      Poor
    2. Speaking :
      Excellent  
      Good  
      Fair  
      Poor
    3. Writing :
      Excellent  
      Good  
      Fair  
      Poor
    4. Reading :
      Excellent  
      Good  
      Fair  
      Poor
      

    2. Others : (Please specify)

    1. Listening :
      Excellent  
      Good  
      Fair  
      Poor
    2. Speaking :
      Excellent  
      Good  
      Fair  
      Poor
    3. Writing :
      Excellent  
      Good  
      Fair  
      Poor
    4. Reading :
      Excellent  
      Good  
      Fair  
      Poor
      

    3. Others : (Please specify)

    1. Listening :
      Excellent  
      Good  
      Fair  
      Poor
    2. Speaking :
      Excellent  
      Good  
      Fair  
      Poor
    3. Writing :
      Excellent  
      Good  
      Fair  
      Poor
    4. Reading :
      Excellent  
      Good  
      Fair  
      Poor
        

    E. Certificate obtained in language


    1. Name of Certificate* :
    2. Language* :
    3. Year Obtained* :
    4. Name of Institution&Country* :
    5. Score* :
    6. Endorsed by* :
      Eg: Ministry International Body
      
    1. Name of Certificate :
    2. Language :
    3. Year Obtained :
    4. Name of Institution&Country :
    5. Score :
    6. Endorsed by :
      Eg: Ministry International Body
      
    1. Name of Certificate :
    2. Language :
    3. Year Obtained :
    4. Name of Institution&Country :
    5. Score :
    6. Endorsed by :
      Eg: Ministry International Body
        

    F. Institution & Program


    1. Institution Name* :
    2. Program* :
    3. Training Duration* :
        

    G. Financial Guarantee Declaration


    1. Student Name* :
    2. Program Name including Level of study* :
    3. Institution Name* :
    4. Estimated length of study duration* :
    5. Name of financial guarantor/sponsorer* :
    6. Address of sponsorer* :
    7. Tel No* :
    8. Fax No* :
    9. Email* :

    **This letter is to verify that I will support the student while he/she studies in the program at the Institution stated. I understand that he/she intends to study for the estimated length and I will support him/her financial for this length of time.

    Note : Please include the original signed letter of sponsorship or scholarship or funding authority. Click Here

        

    H. Medical History


    Please download the from. Click Here

        

    I. Declaration


    1. Have you ever been convicted by a Court Law of any country?

      If Yes, please give details :


    Yes No



       b. If accepted for the training program, I agreed to :

    1.   Carry out such instructions and abide by such conditions as stipulated by the rules of law of the Government of Malaysia;
    2.   Follow the training and abide by the rules of the institution in which I undertake to study or train;
    3.   Refrain from engaging in political activities, or any form of employment for profit or gain; and
    4.   Return to my home country promptly upon the completion of mytraining.

    I herewith certify that my statements above mentioned in this form are true, complete and correct.

    Note : Please include the original signed letter of declaration. Click Here