DYDW-01

Passport
YOUTH DEVELOPMENT STUDIES UNIT, DEPARTMENT OF PROFESSIONAL Size
DEVELOPMENT AND CONTINUING EDUCATION, FACULTY OF EDUCATIONAL Photo
STUDIES,43400 UPM SERDANG, SELANGOR, MALAYSIA

APPLICATION FOR ADMISSION

Please ensure that this form is completed and all the relevant documents indicated in the
check list on page 5 are enclosed. Incomplete forms and/or documents will not be processed.

PART A TO BE COMPLETED BY THE APPLICANT

I PERSONAL DETAILS

Full name : ______________________________________________________________________________________

First name Middle name Last name

Malaysian – Please write your name according to I.C

I.C/Passport No. : ____________________________________ Date of birth_________________________________

Place of birth : ______________________________________ Race : ______________________________________

(for Malaysian Only)

Sex (please tick): Male Female Nationality : ______________________________________

Marital Status (please tick) : Single Married Others

Correspondence address :
________________________________________________________________________________________________

________________________________________________________________________________________________

Country : _____________________________________ Post code : ________________________________________

Telephone no: Fax.no: E-mail address:

Permanent address (if different form correspondence address) :

________________________________________________________________________________________________

________________________________________________________________________________________________

Country : ____________________________________ Post code : ________________________________________

Telephone no: Fax.no: E-mail address:

UPM/YDSU/DYDW-01 1/5
II EDUCATIONAL BACKGROUND

Name of Degree awarded Year Specialisation

University/College/School Admission Graduation

III Working Experience

Work Experience: ________ years

Duties/Tasks

Position held Name and Address of Employer From To

If space is inadequate, please attach appendix

Last salary: RM ____________

Employer’s endorsement: Date__________ Name:______________________________ _________________

Signature & Stamp
Involvement in Youth/Social Work (please attach appendix)

Other relevant qualifications

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

UPM/YDSU/DYDW-01 2/5
IV NEXT-OF-KIN

Name : ___________________________________________ Relationship : _________________________________

Permanent address : _______________________________________________________________________________

________________________________________________________________________________________________

Country : __________________________________ Post code : ___________________________________________

Telephone no: Fax.no: E-mail address:

Please describe your language proficiency

Language Oral Written

Excellent Very Good Good Excellent Very Good Good

Malay Language

English Language

Other Languages

V DETAILS OF PROGRAMME APPLIED FOR

Field of study : _________________________________________________________________________________

Faculty/Institute : _________________________________________________________________________________

Preferred semester for enrolment : Mei November

Year : _____________________________

VI FINANCIAL INFORMATION

Profession wife/husband: ___________________________

Income wife/husband: RM __________________________

To participate in this programme I shall:

Bear all the cost on my own

Get sponsorship from my employer

Get a scholarship

Get a loan

Other means (please indicate):

UPM/YDSU/DYDW-01 3/5
VII ENGLISH LANGUAGE PROFICIENCY
Please complete the information below (where relevant) and provide a copy the results:

EXAMINATION SCORE/GRED

SPM (Malaysian only)

Others equivalent to SPM

VIII ENDORSEMENT

I hereby declare that all the information above is true and all certificates and examination results are valid. I
understand that Universiti Putra Malaysia has the right to reject and cancel the offer or request me to leave the
programme if any of the information, certificates and other documents are false.

Signature of applicant : ______________________________ Date : _____________________

UPM/YDSU/DYDW-01 4/5
Name of Organisation Position/ Role/Task/Experience Certificate Certified by KBS, JBS, Head of Department/ Organization) (Date &
Duration Signature)

UPM/YDSU/DYDW-01 5/5
IX CHECK LIST FOR APPLICANT

Please enclose the following items in order to expedite the process. Please tick [ / ].

For Malaysian applicants

Completed application form DYDW-01 – two copies

Passport size photograph – two copies

Certified photocopy of identity card – two copies

Certified copy of Certificate/Examinations Results - two copies

Application processing fee RM 25.00, payble to the Bursar, UPM

Copy of document on involvement in youth/social work – two copies

Certificate/Score on English Test – two copies

Document on sponsorship – two copies

For International Applicants

Completed application form DYDW- 01 – two copies

Passport sized photograph – three copies

Certified photocopy of passport (pages with photograph, personal particulars and validity for at least one
Year) – three copies

Processing fee, payble to the Bursar, UPM : USD25 (for those who apply from outside Malaysia (if any)-
two copies

Certified photocopy of letter of scholarship/sponsorship award (if any) – two copies

GUIDE TO FILL IN THE APPLICATION FORM

REMINDER

○ Read the instructions carefully before filling in the form

○ The application will not be considered if the form is in complete
○ Use ball point pen

A. APPLICANT’S INFORMATION

1. Full name - Fill in the name as in the identity card in CAPITAL LETTERS. Use one letter
for one box and leave empty between two words.

2. Identity card number (new and old) - fill in the number from the left. For the old IC number,
the first box is for the letter (A, S etc.) and followed by the numbers.

3. Sex - Please tick the appropriate space

4. Race - Please indicate your race using the following code:

Code Race Code Race

M Malay C Chinese
I Indian H Bumiputera Sabah
K Bumiputera Sarawak A Orang Asli Semenanjung
L Others

5. Religion - Please indicate your religion using the following code:

Code Religion
I Islam
B Buddha
H Hindu
K Christian
L Others

6. Marital status -Please tick the appropriate space

7. Nationality
Code Nationality Code Nationality
M Malaysia S Singapura
P Penduduk Maustautin B Brunei
I Indonesia L Others

8. Profession : Indicate your present job

9. Date of birth - Please indicate your date of birth by day/month/year

10. Place of birth - Indicate which state were you born

Code State Code State

A Perak N Negeri Sembilan
B Selangor P Pulau Pinang
C Pahang R Perlis
D Kelantan S Singapura
E Thailand T Terengganu
I Indonesia V W.P. Labuan
J Johor W Kuala Lumpur
K Kedah X Sabah
Y Sarawak U Brunei
M Melaka L Others

11. Handicaps - Please indicate if you have any physical defects

12. Internet - If you are accessible to internet facilities

13. E-mail - Please write your e-mail address

14 and 15. Mailing address - Please indicate your home and/or office address

ACADEMIC INFORMATION

16. SPM/SPVM/MCE results - Please indicate the examination taken, year, stream (art or science
etc), aggregates and grade for each subject taken. Please attach a certified copy of the
results..

17 STPM/STP/HSC - Please indicate the examination taken, year, stream (art or science etc),
aggregates and grade for each subject taken. Please attach a certified copy of the results.

18. Please indicate the name of the institute of higher learning you have attended, year of
graduation, program (certificate/diploma/bacelor), specialization (if any) and the examination
results. Please attach a certified copy.

19. Please indicate your language proficiency

CAREER INFORMATION

20. Working experience -Please indicate the years of experience

21. Indicate the task/duty

22. Your last pay

23. Get the signature and stamp of your employer.

24. Indicate your involvement in youth/social work. Please attach a certified copy. Get it
endorsed by the organisation.
FINANCIAL

25. Please indicate your wife/husband’s present job

26. Indicate your wife/husband’s latest salary amount

27. Please tick (X) in the appropriate box

CHECKLIST

Please tick (X) in the appropriate boxes

a. Signed the application form

b. Passport size photo
c. A certified copy of identity card
d. Ceritified copies of examination results
e. Reply form (with stamp)
f. Processing fee of RM 25.00 (receipt no.)

F. ENDORSEMENT

Please read carefully. Write the date and sign the form.

Please return the completed application form before or on the closing date (as advertised) to the
following address:

Youth Development Studies Unit

Department of Professional Development and Continuing Education
Faculty of Educational Studies
Universiti Putra Malaysia
43400 UPM, Serdang Selangor.

Tel : 603-89468239 / 603-89468229

Fax : 603-89450455