Application for Admission : Kyoto Institute of Technology Page 1 of 3

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Confirmation of Application for Admission -Short-term Internship Program-

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1Name in full, in English

BIN MOHD SALLEH NUR AREISMAN

2Nationality

Malaysia

3Date of birth

15th October, 1990

4Sex

Male

5Present status at your home institution

(i) Name of the home institution

UNIVERSITY MALAYA

(ii) Academic program in which you are enrolled and current school year at your home institution

Doctoral Program 0
Date of Enrollment (above mentioned program): 6th February, 2017
Date of expected graduation(above mentioned program): 31st January, 2019

(iii) Department and major

DEPARTMENT OF MECHANICAL ENGINEERING, MAJOR IN MATERIAL SCIENCE.

https://www.international.kit.ac.jp/?c=application_form 26-Apr-17
Application for Admission : Kyoto Institute of Technology Page 2 of 3

6Current address and phone number

Address 60-1-20 TAMAN SRI MURNI, 68100 KUALA LUMPUR, MALAYSIA

Phone +60133151848

7Permanent address and phone number

Address 60-1-20 TAMAN SRI MURNI, 68100 KUALA LUMPUR, MALAYSIA

Phone +60133151848

8E-mail address

nurariesmansalleh@gmail.com

9Person to be notified in applicants home country in case of emergency

(i) Name in full

MOHD SALLEH BIN NAWARI

(ii) Address and phone number

Address 60-1-20 TAMAN SRI MURNI, 68100 KUALA LUMPUR, MALAYSIA

Phone +60192074466

(iii) Occupation
RETIREES

(iv) Relation to applicant

FATHER

10Period of Stay at KIT

Indicate your prospective period of stay at KIT.

Period of Stay at Kit from 5th July, 2017 to 12th July, 2017

https://www.international.kit.ac.jp/?c=application_form 26-Apr-17
Application for Admission : Kyoto Institute of Technology Page 3 of 3

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https://www.international.kit.ac.jp/?c=application_form 26-Apr-17