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STUDENT REGISTRATION FORM / BORANG PENDAFTARAN PELAJAR

Year / Tahun 2015

STUDENT S DETAIL

HQ : USJ 9, Subang Jaya

For Office Use Only

Maklumat Pelajar

Student Code

Name
Nama

Administration Date

Gender
Jantina

Male / Lelaki
Female / Perempuan

Registration Date

School
Sekolah

/
d

Address
Alamat

Date of Birth
Tarikh Lahir
HP No.
No. Tel Bimbit

Email

Home No.
No. Tel Rumah

PHOTO
Passport Size
Saiz Pasport

Academic Level
PeringkatAkademik
Form / Tingkatan 1 / 2 / 3 / 4 / 5 / 6
Primary / Darjah 1 / 2 / 3 / 4 / 5 / 6

TUITION CLASSESKelas - kelas Tuisyen

B Melayu

Geografi

Ekonomi Asas

Chemistry

GUARDIAN / PARENTS DETAIL Maklumat Penjaga / Ibubapa Pelajar


Father / Guardians Name
English
Nama Bapa / Penjaga

HP No.
Perdagangan
No. Tel Bimbit

Sejarah

Physics

Occupation
Pekerjaan
Email Add:
Alamat Email:

If Guardian, what is the relation with the student


Jika Penjaga, apakah hubungan dengan pelajar

Mathematics

Mandarin

Prinsip Akaun

Mothers Name
Nama Ibu

HP No.
No. Tel Bimbit

Biology

Occupation
Pekerjaan

Science

Additional Math

BM Penulisan

SIBLINGS
DETAIL Maklumat Adik - Beradik
Name

Academic Level (Age)


Peringkat Akademik (Umur)

Nama
1.

2.

3.

OTHERS
4.

1. SMS Notification
Notifikasi SMS

Lain-Lain
Yes / Ya
No / Tidak

3. TRANSPORTATION
REQUIRED
5.
Kemudahan pengangkutan

If Yes, please select one (1) only


Jika Ya, tolong pilih satu (1) sahaja

Father / Bapa
Mother / Ibu

2. How do you know about Mastermind?


Bagaimana anda dapat mengetahui mengenai Mastermind?
banner

signboard

leaflet

email

website

media

Yes / Ya
No / Tidak

If Yes, please fill up TRANSPORTATION FORM at the back page.


Jika Ya, sila isi BORANG PENGANGKUTAN di muka belakang.
6.

tutor

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