BORANG PERMOHONAN PROGRAM UKM-GLOBAL STUDENT MOBILITY PARTNERSHIPS

Transcription

1 Program you are applying (Kindly choose either one): 1. STPD4044: Sustainability of Tropical Heritage 2. SKZA2014: Indigenous Communities of Malaysia Attach one recent passport photograph (3.5 cm x 5.0 cm) Note: Please type or write clearly in BLACK / BLUE INK. SECTION A: STUDENT INFORMATION 1. Full Name: 2. Gender: Male Female 3. Date of Birth: / / 4. Passport Number: 5. Expiry Date: 6. Identity Card Number (Malaysian only): Country of Citizenship: 8. Address (For correspondence regarding this application): 9. City: 10. State: 11. Country: 12. Postcode: 13. Phone No.: SECTION B: ADDITIONAL INFORMATION 1. Medical Health Clarification: Good No (Please state): 2. Dietary Requirements: 3. Size of tshirt: S (Shoulder 17, Length 25 ) XL (Shoulder , Length 28 ) M (Shoulder , Length ) Others (Please state): L (Shoulder 20, Length 27 ) 1 5

2 SECTION C: HOME UNIVERSITY Please provide details of your home university in the space below. 1. Name of University 2. Address of University 3. Degree for which you are currently registered 4. Faculty/ Department 5. Year of study at the time of application # 2 nd year 3 rd Year 4 th Year 6. Student ID Number 7. Grades or CGPA ## Name: 8. Student Mobility Coordinators (Home University) Address: Tel. No.: (Country Code + Area Code + Number) Academic Requirements: # Applicants must have completed at least one year of university study at the time of participation in UKM- GSMP. ## Students hold at least a 3.0 GPA (Grade Point Avarage) on a 4.0 scale and enclose certified copies of your academic transcripts. 2 5

3 SECTION D: PERSONAL STATEMENT Please write a 200 words statement in the space provide below. Please write about yourself with details of: (a) Your reasons for wishing to participate in UKM-GSMP; (b) Why you have chosen UKM; (c) Your educational objectives, your professional goals and aspirations; (d) How this mobility programme would help you achieve your academic and professional goals. 3 5

4 SECTION E: APPLICANT DECLARATION All applicants must read the following information and sign. 1. I agree to abide by the statutes and regulations of Universiti Kebangsaan Malaysia (UKM). 2. I declare that the information presented in this application and the accompanying documentation is true, correct and complete. I acknowledge that UKM may terminate my enrolment if false information has been supplied. 3. I authorise UKM to release information regarding my application to the Immigration Department of Malaysia and other agencies where UKM considers the information relevant to my immigration status. 4. I am aware of the costs associated with the UKM GSMP and I have the necessary financial capacity to meet such costs for the duration of my participation in the programme. I understand that if I am unable to meet the costs, UKM will not be expected to help me. 5. I understand it is my responsibility to arrange and pay for my international flights, visa and insurance prior to my arrival in Malaysia. 6. I understand that I must enrol in and complete the UKM GSMP. I can only withdraw from this UKM GSMP with the written approval of the Dean, Faculty of Social Science and Humanities, UKM or Dean, Faculty of Science and Technology, UKM. Signature Date: SECTION F: HOME UNIVERSITY ENDORSEMENT DEAN / STUDENT MOBILITY COORDINATOR S SIGNATURE Title and Name: Position: Dean Student Mobility Coordinator Signature and Official Stamp Date: Please Return This Completed Form To: Director of International Relations Centre (UKM Global), Universiti Kebangsaan Malaysia Level 2, Chancellory Building, 43600, Bangi, Selangor, Malaysia. gsmp@ukm.edu.my 4 5

5 APPLICATION CHECKLIST ( ) Subject Completed all sections in this application form. Read the declaration, signed and dated this application form. Endorsement from your Dean or Student Mobility Coordinator. Enclosed a certified photocopy of your current passport. Enclosed your other supporting documentations related to your application. Enclosed certified copies of your academic transcripts. Attached one recent passport photograph. Write your name and student ID number on the back. 5 5