application form All correspondence should be addressed to YTL International College of Hotel Management Starhill Gallery, SHC/T12 Level 1A-2, 181 Jalan Bukit Bintang 55100 Kuala Lumpur Malaysia Tel 018-799 7000 018-799 7008 018-799 7009 Fax 018-799 7004 www.ytl-ichm.edu.my provide 4 passport size photos I wish to apply for enrolment in the course name which begins in / identification Name (as in IC/Passport) Name of Parents/Guardian Relationship Date of Birth Sex Male Female Address Country of Birth Passport./IC. Nationality Religion Race Address for Correspondence (mailing address) Phone Fax Do you have permanent residency status in Malaysia? (if yes attach evidence) How did you hear about YTL-ICHM? Home Tel Work Tel Mobile Fax Page 1 of 6
education education provide details of all education and training that you have successfully or part-completed. provide Attach details evidence of all education of completion and of training course. that you h Name of Institution or School Title of Course Title of Course (e.g. 2000-2002) Successfully Completed Name of or Sc Supporting documentation must be attached employment employment If you have worked in the hospitality and tourism industry, please attach evidence If you of this have experience. worked in (eg. the hospitality a letter from andemployer) tourism industr Type of Work Country Name of Establishment Full Time / Type of Work Part Time Length of Time s/months Name of Es Supporting documentation must be attached language knowledge language knowledge English Proficiency if you are an International student, please provide details of your English English Proficiency language if you qualifications. are an International student, pl IELTS (Score) TOEFL (Score) Date obtained IELTS (Score) TOEFL (Score) an English language course Will you attend an English language course prior to commencing at YTL-ICHM? Will you attend prior to comm Supporting At which school At which school documentation must be attached Other Languages For each language that you speak, write and/or read please indicate Other Languages the level of fluency. For eachuse language the following that you code speak, wri 1. Extremely well in all situations 1. Extremely well in all situations 2. Very well in predictable situations 2. Very well in predictable situations 3. With some difficulty in predictable situations 3. With some difficulty in predictable situ 4. With great difficulty in predictable situations 4. With great difficulty in predictable situ 5. knowledge 5. knowledge Language Speak Write Read Did you study this language? Language Speak If yes, how many hours of study? Writ attach evidence of language study (including mother tongue e.g. high school attach results) evidence o Which language do you consider your mother tongue? Which language do you consider your mother tongue? recognition of prior learning / credit transfers recognition of prior learn Recognition of Prior Learning/Studies Students Only If yes, in what year will you be enrolling 1 Are you applying for recognition? Recognition of Prior Learning/Studies Students Only 2 If yes, in what year will you be enrolling 1 Page 2 of 6 Y
medical form immunisation This form Malaysian must be completed by allsend signature and stamp. Malaysian send formspecify with numb ature and stamp. must form and with include a doctor s Has the applicant been immunised against ( must or ). application. International may get this form completed at their Student Visa Health Check and then send separately to the udent Visa Health Check and then send separately to the Diptheria YTL-ICHM Admissions Office. Whooping Cough Parents and arehealth requested to advise YTL-ICHM of any condition(s) that may affect the student s health or of any Important condition(s)te that may affect the student s or ability to complete the course and/or work in the hospitality industry. Tetanus please write in block letters Hepatitis ess for Correspondence Family Name (mailing address) l Poliomyelitis Address for Correspondence (mailing address) other medical Given Names Do you have allergies to any foods, medicines, insects etc? If yes, please spe English Name (if applicable) Date of Birth Tel Sex Male Female Fax Do you have any disabilities which may affect your capacity to study at YTL-I medical history If yes Visual Hearing Dyslexia Other please spec Will you require any special assistance owing to this disability? If yes please ppropriate box(es) for each complete thecondition). following with regard to your medical history (Tick the appropriate box(es) for each condition). Presently Medical Suffering Condition Never Suffered Have Been Immunised Against Previously Suffered Appendicitis Asthma Diabetes Diptheria Epilepsy Heart Trouble Hepatitis Type Type Malaria Measles Mental Illness Mumps Poliomyelitis Rheumatism Rubella Tetanus Tuberculosis (BCG) Typhoid Fever Whooping Cough Any other medical/surgical history (specify) Page 3 of 6 Presently Never Have Been general impression of Immunised applicant s m Suffering Suffered Against complete The undersigned doctor certifies that the general state of health, physical an applicant is not the carrier of any infectious disease, has no physical disability professional training in the hotel and restaurant industry without risk to thems Signature and stamp of doctor Page 3 of 6
immunisation Has the applicant been immunised against ( or ). specify number of doses and dates. Diptheria Whooping Cough Tetanus Poliomyelitis Hepatitis other medical Do you have allergies to any foods, medicines, insects etc? If yes, please specify Do you have any disabilities which may affect your capacity to study at YTL-ICHM? If yes Visual Hearing Dyslexia Other please specify Will you require any special assistance owing to this disability? If yes please specify general impression of applicant s medical condition complete The undersigned doctor certifies that the general state of health, physical and mental condition of the applicant is satisfactory, that the applicant is not the carrier of any infectious disease, has no physical disability and could therefore comply with the strict requirements of professional training in the hotel and restaurant industry without risk to themselves and other persons. Signature and stamp of doctor Date Page 4 of 6
referee referee identify the minimum of 1 person whoprovided. can provide info identify minimum of 1 person who can provide information on your character and confirm information you have Referees should not be family members. Referees should not be family members. Name Name Address Address Phone Fax Phone Fax Written reference form enclosed Written reference form enclosed Referee will post reference form direct to YTL-ICHM Referee will post reference form direct to YTL-ICHM guarantor / financial sponsor (personguarantor paying fees) / financial spon declaration by guarantor (1) Name (1) Name Address Phone Address I acknowledge that I have read and understand the Conditions of Enrolment. I have read the conditions as stated concerning notice of cancellation and declare that I will abide by terms and conditions therein. Fax Guardian/ Phone Sponsor Signature Passport. / IC. Fax Date declaration by applicant Passport. / IC. declaration by applicant I acknowledge that I have read the YTL-ICHM Prospectus. I further acknowledge I that acknowledge all the information that I have provided read the in this YTL-ICHM application Prospectus form is correct, that I have read the Conditions of Enrolment containing notice of form cancellation is correct,and thatdeclare I have that readi the will Conditions abide by the of Enrolm terms and conditions therein. I agree to be bound by the College's Conditionsterms of Enrolment and conditions and acknowledge therein. I agree that all to be disputes bound by th arising from the details and conditions contained in this application shall be governed arising by and from construed the details in accordance and conditions withcontained the Laws in of this ap Malaysia and be submitted to the jurisdiction of the Courts of Malaysia. I consentmalaysia to YTL-ICHM and be using submitted my photograph to the jurisdiction for YTL-ICHM of the Court marketing and promotional materials use. I hereby give permission to the College marketing to pass and my relevant promotional information materialsconcerning use. I hereby any give p results and progress at the College to my Parents/Guardian and the Human Resource results and Departments progress of at Hotels the College in which to my I apply Parents/Guard to complete my undergraduate industry placements. complete my undergraduate industry placements. Applicant's Signature Applicant's Signature Date Page 5 of 6
application form application form All correspondence should be addressed to checklist YTL International College of Hotel Management Starhill Gallery, SHC/T12 Level 1A-2, Formal documents of completed education 181 Jalan Bukit Bintang 55100 Kuala Lumpur transcripts, reports Certified etc) copy of your education documents (school, college, Malaysia university transcripts, reports etc) Tel 018-799 7000 018-799 7008 Evidence of relevant work experience 018-799 7009 Fax 018-799 7004 Medical Report www.ytl-ichm.edu.my The following must be sent with the completed application form ation first; then Medical have Form this form (International completed at may submit the rest of their application first; then have this form completed at student visa check and then send) ue) Four (4) passport size photographs Evidence of relevant employment I wishtongue) to apply for enrolment in the course name Evidence of English language fluency (if English is not the mother OR Evidence of education in mother tongue (high school results) Evidence of citizenship (e.g. copy of passport personal detail which page) begins in / Payment of application fee. identification important Name (as in IC/Passport) Relat note student fees may be paid by bank draft, bank cheque or direct bank transfer ct bank transfer Date of Birth IT to Name direct bank transfer Country of Birth Account Bankers Name CIMB YTLBhd. HOTEL MANAGEMENT SERVICES SDN BHD Passport./IC. Account Number 1419-0050297-05-8 Nationality Sex Male Female Addre Bankers CIMB Bhd. bank draft / bank chequereligion Race make bank drafts or bank cheques payable in MALAYSIA RINGGIT to Address for Correspondence (mailing address) "YTL HOTEL MANAGEMENT SERVICES SDN BHD" Phone and mail to YTL HOTEL MANAGEMENT SERVICES SDN BHD 11TH Floor YTL Plaza 55 Jalan Bukit Bintang 55100 Kuala Lumpur Do yo Y Accont Number 1419-0050297-05-8 How Home Tel Work Tel Mobile Fax Page 6 of 6 Page 6 of 6