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UKM/PPS/G/PO2/AK04/1

APPLICATION FORM FOR ADMISSION INTO POSTGRADUATE PROGRAMMES


SEMESTER _______SESSION_______________
INSTRUCTIONS TO APPLICANT 1.
Please attach a passportsized photograph

2013/14

2.

Fill out this application form and submit by mail together with supporting documentation and application fee to the Graduate School of Business, Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor, Malaysia. Please refer to the application check list (UKM-GSB 01) and ensure that the copies of documents needed are sent to the GSB.

REFERENCE NUMBER: UKM-GSB 1.38 __________________


(For office purpose only)

A.

PERSONAL DETAILS

Last Name: MOHD First Name:

AZHAR BIN OTHMAN

Gender: Male / Female MALE Date of Birth:


[Day/Month/Year]

Note: Name should be written in upper case letters and as it would appear on the identity card/ international passport.

07 / 10 / 1983

Country of Origin: MALAYSIA Permanent Resident: MALAYSIA Nationality: MALAYSIAN

Place of Birth:
(Malaysian only)

KUALA LUMPUR

Age: 30 Marital : Single / Married MARRIED Religion: ISLAM Ethnicity: Malay / Chinese / Indian / Others (Please state): Mobile Phone: 012-2943356 Telephone:
(Number to be contacted for interview)

Identity Card No. or Passport No.: 831007-14-5403 Permanent Home Address:


(Complete Mailing Address with Postcode)

303 BLOK P, SD2 APARTMENT PERSIARAN MERANTI, BDR SRI DAMANSARA, 52200 KUALA LUMPUR

Name, Address and Tel. No. of Person to be Contacted in Case of an Emergency:

WAN AYUNI WAN ROZALI 303 BLOK P, SD2 APARTMENT PERSIARAN MERANTI, BDR SRI DAMANSARA, 52200 KUALA LUMPUR 017-6321436
Name of Contact Person in Malaysia and His/ Her Telephone Number:

012-2943356

Email: azharfcsit@gmail.com Fax no.: 03-2691

WAN AYUNI WAN ROZALI : 017-6321436


B. DETAILS OF THE PROGRAMME [Please choose () only one in the appropriate box]

6995

Master of Business Administration Registration Status:

Full-time MBA (General MBA/MBA with concentration) Proposed Specialisation Area: (tick one in each column)
Specialisation

Part-time MBA (General MBA)

Organizational and Human Resource Management Marketing Islamic Banking and Finance Applied Finance and Investment General

Doctoral Programmes (DBA and Ph.D) Doctor of Business Administration (coursework and dissertation)
B

Specialisation Specialisation

Doctor of Philosophy (by Thesis, with pre-requisite courses)


Note: please refer to GSBs website at www.ukm.my/gsbukm for programme details

Registration Status: Full-time (foreign applicants must register as full-time only) Part-time

Brief Title of Proposed Thesis:

Note: If you are applying into the Ph.D (by thesis) programme, you are required to attach your write-up (of between 1,500- to 2,000 words) or your Ph.D research proposal. This should contain your research problem formulation, literature review and conceptual framework, methodology, managerial implications and key references.

C. ACADEMIC AND PROFESSIONAL QUALIFICATIONS Academic Qualification

Name of Institution: UNIVERSITY Country of Study: MALAYSIA Major Field of Study: SOFTWARE Qualification Obtained:

OF MALAYA
Graduation Date (years/months): 08/2008

ENGINEERING

Duration of Study (No. of years/months): 5

YRS

(e.g. Bachelor of Accounting, Master of Finance etc)

BACHELOR DEGREE OF COMPUTER SCIENCE


Results Achieved:
(Average grade point. E.g. CGPA 3.5 out of 4)

Dominant Medium of Instruction:


(e.g. English/ Arabic/ Malay etc)

ENGLISH

2.46

Name of Institution: Country of Study: Major Field of Study: Qualification Obtained:


(e.g. Bachelor of Accounting, Master of Finance etc)

Graduation Date (years/months): Duration of Study (No. of years/months):

Dominant Medium of Instruction:


(e.g. English/ Arabic/ Malay etc)

Results Achieved:
(Average grade point. E.g. CGPA 3.5 out of 4)

Name of Institution: Country of Study: Major Field of Study: Qualification Obtained:


(e.g. Bachelor of Accounting, Master of Finance etc)

Graduation Date (years/months): Duration of Study (No. of years/months):

Dominant Medium of Instruction:


(e.g. English/ Arabic/ Malay etc)

Results Achieved:
(Average grade point. E.g. CGPA 3.5 out of 4)

Note: Please enclose certified copies of degree certificates and degree transcripts as evidence of above

Title of any Thesis/ Dissertation Submitted for Degree Award Title Bsc/Msc Year Submitted

Note: We define this as scholarly/academic writing of at least 50,000 words in length.

Professional Qualifications (if any) Qualification Obtained Year Awarded Awarded by

MICROSOFT CERTIFIED PROFESSIONAL

2007

MICROSOFT CORPORATION

MICROSOFT CERTIFIED SYSTEM ADMINISTRATOR MICROSOFT CERTIFIED SYSTEM ADMINISTRATOR : MESSAGING


Note: Please enclose certified copy of professional qualification certificates.

2007 2007

MICROSOFT CORPORATION MICROSOFT CORPORATION

D. ENGLISH LANGUAGE PROFICIENCY QUALIFICATION Name of Examination/Test: TOEFL/IELTS

Competency Level/Band Score:

Year Taken:

Note: Please enclose certified copy/evidence of : i. Competency level achieved in either TOEFL/IELTS ii. Foreign students whose native language is not English and those who earned degrees where English is not the medium of instruction, who do not submit these scores will not have this application processed.

E. BRIEF FULL-TIME EMPLOYMENT SUMMARY Current position and Area of Responsibility: SENIOR

EXECUTIVE : STUDENT EXCELLENCE TRANSFORMATION OFFICER. Responsibility to plan, arrange, manage and implement all student excellence program for Yayasan Pelajaran MARA especially for rural area in Malaysia.

Name and address of organizations currently working in: YAYASAN

Telephone: Date From:


(month/year)

PELAJARAN MARA LEVEL 17, MENARA MARA, 232 JALAN TUANKU ABDUL RAHMAN 50100 KUALA LUMPUR 03-2692 7273 (EXT : 108)

12/2010

Duration of Working with current employer:


(month/year)

3 YRS

Previous Position:
(Work experience after first degree, if any)

Job Title or Position Held

Name of Company/organization

Date From
(month/year)

Date To
(month/year)

Length of Service

IT SUPPORT ASSISTANT

MONT KIARA INTERNATIONAL SCHOOL

04/2008

11/2010

2.5 YRS

WEB EXECUTIVE

ELDERAAN TECHNOLOGIES SDN BHD

02/2008

04/2008

2 MTHS

F.

REFEREES

(Name two (2) referees. For applicants into the doctorate programme, both referees should be academics who have taught you and are capable of reporting your academic performance. For applicants into the masters programme, at least one referee should be an academician. Immediate family members do not qualify as referees. ). Academic Referee 1 Name Position Address Academic Referee 2

SITI HAFIZAH ABDUL HAMID SENIOR LECTURER

MOHD YAMANI IDNA IDRIS SENIOR LECTURER

FACULTY OF COMPUTER SCIENCE & INFORMATION TECHNOLOGY, UNIVERSITY OF MALAYA, LEMBAH PANTAI, KUALA LUMPUR
0126673678
03-79676339

FACULTY OF COMPUTER SCIENCE & INFORMATION TECHNOLOGY, UNIVERSITY OF MALAYA, LEMBAH PANTAI, KUALA LUMPUR
03-79676414

Phone No. Faks No. E-mail

sitihafizah@um.edu.my

yamani@um.edu.my

Note: Applicants into Masters programmes can substitute the second academic referees to be one from the corporate/industry sector.

G.

FINANCIAL SUPPORT (Please tick [] in the appropriate box) I am fully sponsored by my employer/home government. (Please enclose official letter(s) of Financial Guarantee from your sponsoring institution) Name and address of sponsor:

I am a private student supported by my family/self funding (Please complete and submit the Financial Guarantor form UKM/PPS/G/PO2/AK04/3)

H.

DECLARATION

I, the undersigned, declare that I have read and understand that all information and documentation provided in the application are, to the best of my knowledge, true and complete. I understand that any false statement or omission, even if unintended on my part, may result in a delay or a rejection of my application. Finally, if I am offered and accepted to enroll in the postgraduate programme, I agree to abide by the rules and regulations of Graduate School of Business and the Universiti Kebangsaan Malaysia.

OTHMAN
Last Name: .

MOHD AZHAR
First Name: ..

Signature of Applicant .

Date:

(Please note that forms without the signature of the applicant will not be considered complete and hence will not be processed)