APPLICATION FORM FOR UNIVERSITY ADMISSION

Transcription

1 APPLICATION FORM FOR UNIVERSITY ADMISSION Method of Enquiry: Walk-In Referred by / Agent: Others ATTACH RECENT International Student Applicant (checklist) PHOTO The following documents and Application Fee must be submitted with your application for admission YES NO 1. Application Fee (non-refundable) of RM via Telegraphic Transfer (TT): Payee Name: Quest International University Perak (QIUP) Bank Name: CIMB Bank Berhad Account Number: Swift Code: CIBBMYKL 2. Certified True Copies of all Academic Qualification Certificates e.g. O Level / / A Level / CIMP / SAM / Others Proof of English Language Proficiency e.g. IELTS or TOEFL, if applicable 4. Two (2) Certified True Copies of Passport (all pages, including empty pages) (Validity of passport must be at least one (1) year) 5. Eight (8) Passport-Sized Photographs (blue background) 6. Financial Statement Form for Foreign Students 7. Letter of Attestation Declaration from a Commissioner of Oaths/ Embassy Official in support of any discrepancy in name or date of birth on the passport and academic transcript 8. Certified Medical Health Examination Report Form 9. No Objection Certificate from Ministry of Education (for students from Sub-Sahara countries only) Note: Please write applicant s name on the bank transaction slip and send it with the Application Form to QIUP Application Form for University Admission Page 1 of 6

2 PROGRAMME APPLIED FOR (please tick) Foundation in Science (A 9504) Foundation in Business (A 9505) Bachelor of Computer Science (Hons) (PA 10305) Bachelor of Business Administration (Hons) (PA 10306) Bachelor of Business Administration (Hospitality & Tourism Management) (Hons) (PA 2255) Bachelor of Accountancy (Hons) (PA 1732) Bachelor of Arts (TESL) (Hons) (PA 2258) Bachelor of Medicine & Bachelor of Surgery (MBBS) (PA 0241) Bachelor of Finance (Hons) (PA 2256) Bachelor of Engineering (Hons) Electronics & Communications Engineering (PA 2259) Bachelor of Science (Hons) in Biotechnology (PA 2343) Diploma In Hotel Management (PA 3705) Diploma In Business Management (PA 3706) Diploma In Accountancy (PA 3703) Master of Business Administration (PA 3704) PERSONAL PARTICULARS Name as stated in the NRIC / Passport (in capital letters): Gender: Male Female Nationality: Date of Birth: Age: Marital Status: NRIC / Passport No: Race: Religion: Single Married Others Application Form for University Admission Page 2 of 6

3 CONTACT DETAILS Postal Address: Post / Zip Code: City / State: Country: Home Tel No: Mobile Phone No: Address (compulsory): PARENT S / GUARDIAN S PARTICULARS Parent / Guardian Name: (as in NRIC / Passport) NRIC / Passport No: Correspondence Address: Home Tel No: Office Tel No: Mobile Phone No: Postcode: Employer: Occupation: Address: Monthly Income: Relationship (if guardian): Emergency Contact (other than parents) Name: (as in NRIC / Passport) Relationship: Correspondence Address: Home Tel No: Office Tel No: Mobile Phone No: Address: Application Form for University Admission Page 3 of 6

4 ACADEMIC QUALIFICATIONS (Please attach supporting documents) Institution Qualification Year Please provide details of the subjects taken and grades obtained Qualification: Qualification: Subject Grade Subject Grade English Language Proficiency Examination Grade Year IELTS TOEFL English 1119 MUET SOURCES OF FUNDING Financial Support Self-sponsored Sponsored by Institutions(please attach supporting documents) Others (please specify) Application Form for University Admission Page 4 of 6

5 ACCOMMODATION Do you need accommodation? Yes No If Yes, indicate type of accommodation preferred: Single room Shared room Note: Type of room preferred is based on availability DECLARATION Parent / Guardian I, hereby agree to pay all the required fees for the programme of study for which the applicant is enrolled. I also agree to the terms of QIUP s Fee Refund Policy. Signature of Parent / Guardian Applicant I declare that all the information stated in the Application Form is true and correct and all the documents that were submitted upon registration are true copies of the original documents. I understand that Quest International University Perak (QIUP) reserves the right to refuse admission or enrolment made on the basis of incorrect or incomplete information. I agree to abide by all the academic and administrative regulations of Quest International University Perak (QIUP). Signature of Applicant Please return this form to: STUDENT ADMISSIONS & RECORDS DIVISION QUEST INTERNATIONAL UNIVERSITY PERAK (QIUP) No.227, Plaza Teh Teng Seng, Level 2, Jalan Permaisuri Bainun Ipoh Perak Darul Ridzuan Tel: Fax: enquiries@qiup.edu.my Website: Application Form for University Admission Page 5 of 6

6 FOR OFFICE USE ONLY Student Recruitment Division Documents Complete Documents Incomplete Specify : Document to be certified on the Registration Day Counselled by, Signature Name: Selection Committee / Dean / Director Eligible and To Be Offered Rejected KIV (IMPORTANT : PLEASE SPECIFY THE ENTRY REQUIREMENTS THAT MEET/DID NOT MEET THE REQUIRED ENTRY REQUIREMENT) : Signature Name: Student Admissions & Records Division Specify : Documents Complete Documents Incomplete Counselled by, Signature Checked by: Re-checked by: Name: Note : Admission and Records Division shall reserves the right to reject any application with incomplete documents/ information. Application Form for University Admission Page 6 of 6