Documente Academic
Documente Profesional
Documente Cultură
NOTES:
1. Please provide all the information requested and ensure that all testimonials, transcripts and other supporting
documents are submitted together with this form.
2. The application form and all documents must be submitted in TWO sets.
3. Please read the Important Notes to Applicants at the end of this form.
A. PERSONAL DATA
Full Name As In Passport/Identity Card (IN BLOCK LETTERS)
Correspondence Address:
Name and address of nearest relative, person or agency who should be informed in case of emergency:
B. FIELD OF STUDY*
Level of Study: Postgraduate Diploma Master Doctoral
Name of
Programme :
Type of
Programme: Mainstream EXECUTIVE 2) Off Campus 3) Others
(Perdana) 1) Special (Khas) (Pesisir)
F. PUBLICATIONS
(Please attach a separate sheet, wherever necessary)
Extra-curricular activities in school, college and University such as membership of societies, participation in sports etc.
H. FINANCIAL SUPPORT
a) be supporting yourself?
If other people / organisation is paying your tuition fees and living expenses, please provide the name and address
of people / organisation and submit a letter of guarantee from your sponsor / awarding body.
I. REFEREES
Give names and addresses of two senior persons acquainted with your academic work that you have asked to write on your
behalf indicating your academic fitness and general suitability to undertake the course for which you are applying.
(i) (ii)
NAME:
OFFICE ADDRESS:
OCCUPATION/POSITION:
TELEPHONE/FAX NO.:
E-MAIL:
Please state the reasons why you intend to pursue this course and your plans upon graduation.
K. DECLARATION
I certify that the information that I have given in this application 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 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.
……………………………….. …………………………………
Date Signature
1. Please complete this Application Form, enclose all the required documents in TWO SETS and send
them to:
2. The enclosed from the referees should be completed by the referees whose names are given in Section I
of this form. Completed Referees Form duly completed should be sent directly to the above address by
the Referees. If the university does not receive the written form from your referees in time, your
application shall be considered null and void.
3. If you have been rewarded a scholarship, please attach a copy of the offer letter.
4. Incomplete application form or/and in the application is not accompanied by certified true copies of the
candidate’s Degree / Diplomas / Certificates and transcripts shall be considered null and void.
5. If you are an employee, it is your responsibility to obtain a release from the current job or a permission to
register as a postgraduate student at UTM.
6. Please attach a registration and processing fee of RM100.00 for Malaysian applicant and USD100.00 for
international applicants in either a Bank Draft or Cashier’s Order, payable to “BENDAHARI,
UNIVERSITI TEKNOLOGI MALAYSIA”.