ASEANA COLLEGE

The Premier College of Health Science

K O T A K I N A B A L U

REF NO:

APPLICATION FOR ADMISSION

SECTION 1 PREMILINARY INFORMATION/ BUTIRAN PENTING Newspaper Ad
Stick picture here
Lekat gambar sini

PERMOHONAN UNTUK KEMASUKAN

How did you know about us? / Bagaimana anda tahu tentang kami? Road Show
Pameran

Introduced by friends

Iklan surat khabar

Diperkenalkan oleh kawan

Others
Lain-lain:

Telemarketing
Tele-pemasaran

Walk-ins
Datang sendiri

COURSE / Kursus : DIPLOMA IN NURSING STUDIES (KA 9051)

DIPLOMA PENGAJIAN KEJURURAWATAN

FOUNDATION IN SCIENCE (N/010/3/034)

ASASI SAINS

INTAKE / Pengambilan : SECTION 2 PERSONAL INFORMATION / BUTIRAN PERIBADI

Name / Nama (As per IC/Passport)

Seperti di K.P/Paspot

IC / Passport No. Place of Birth /

Tempat Lahir

Nationality /
Warganegara

Race /Bangsa Date of Birth /

Tarikh lahir

Religion/ Agama Marital Status/

Status Perkahwinan

Single /
Bujang

Married /
Berkahwin

Gender / Jantina Correspondence Address/

Alamat Surat Menyurat

Lelaki /
Male

Perempuan/
Female

Age/Umur

Telephone No./
Nombor Telefon

Home /Mobile
Rumah/Bimbit

E-mail / E-mel

Permanent Address/
Alamat Tetap

SECTION 3

PARENT/GUARDIAN INFORMATION/ BUTIRAN IBUBAPA/PENJAGA

Parents / Guardians
Name / Nama Ibubapa / Penjaga

Relationship/ Hubungan Telephone No./

Nombor Telefon

SECTION 4

ACADEMIC/PROFESSIONAL QUALIFICATION/ KELAYAKAN AKADEMIK

Please list all School/College/Professional qualifications that you have taken and their results.
Sila senaraikan semua kelayakan akademik di Sekolah/Kolej/Professional

Year of Examination
Tahun Peperiksaan

Name of Examination
Jenis Peperiksaan

Name of School/College
Nama Sekolah/Kolej

Results/
Keputusan

Please write the result of the following subjects taken in examination

Sila senaraikan keputusan peperiksaan yang terkini bagi mata pelajaran yang diambil.

Subject Bahasa Melayu English Mathematics Science

SPM

SECTION 5 DECLARATION / PENGAKUAN I declare that the information furnished by me is accurate to the best of my knowledge. I have read and fully understood the terms. I further declare that I do not have any previous criminal conviction under the Malaysian Law. Signature of Applicant: Date:

SECTION 6

FOR OFFICE USE / UNTUK KEGUNAAN PEJABAT

Approved by: Remarks:

Aseana College Official Stamp

Result of Application

Approved

Conditional Offer

Rejected

(Marketing)

(Date)

ASEANA COLLEGE OF HEALTH SCIENCE NO 2, LORONG 4, SEMBULAN ARCADE, 88100 KOTA KINABALU SABAH TEL: 088-212415 FAX: 088-212418