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BUSINESS & ADVANCED TECHNOLOGY CENTRE

UNIVERSITI TEKNOLOGI MALAYSIA AFFIX


RECENT
City Campus, JALAN SEMARAK
PASSPORT
54100 KUALA LUMPUR, MALAYSIA SIZED
TELEPHONE: (+6) 03-26914020 FAX: (+6) 03-26911294 PHOTOGRAPH

APPLICATION FOR ADMISSION TO A POSTGRADUATE


PROGRAMME
SESSION *______________ SEMESTER* I (JULY) / II (DECEMBER)

NOTES:
1. Please provide all the information requested and ensure that all testimonials, transcripts and other supporting
documents are submitted together with this form.
2. The application form and all documents must be submitted in TWO sets.
3. Please read the Important Notes to Applicants at the end of this form.

A. PERSONAL DATA
Full Name As In Passport/Identity Card (IN BLOCK LETTERS)

Correspondence Address:

Telephone: Mobile Phone: Fax. No.: This address valid until:

Permanent Address (If different from above):

Telephone: Fax. No.: E-mail:


Country of Birth: Date of Birth: (Day/Month/Year) Age: Identification Card /
___ Years ___Months Passport No.:

Nationality: Sex: Race: Religion:

Marital Status: Number of Dependents:

Name and address of nearest relative, person or agency who should be informed in case of emergency:

Telephone: Fax. No.: E-mail:


Do you suffer from some form of disease / physical or other disability: If so, please specify:

B. FIELD OF STUDY*
Level of Study: Postgraduate Diploma Master Doctoral

Name of
Programme :
Type of
Programme: Mainstream EXECUTIVE 2) Off Campus 3) Others
(Perdana) 1) Special (Khas) (Pesisir)

Mode of Study: Taught Course Taught Course Research


& Research

Form of Registration: Full Time Part Time

Field of Study / Title of Research (for programme by research): ………………………………………………….


………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
(For an application to a research programme, please enclose your research proposal)
C. ACADEMIC ACHIEVEMENT
(Please attach certified copy of your certificate / diplomas / degrees and transcripts)

HIGHER DEGREE QUALIFICATION


NAME OF INSTITUTION YEAR OF NAME OF DATE OF CLASS OF
COLLECE/POLYTECHNIC/ STUDY DEGREE/DIPLOMA DEGREE HONOURS /
UNIVERSITY AWARDED / CGPA
BEING
FROM TO COMPLETED

ENGLISH LANGUAGE PROFICIENCY**


English : Written Excellent ( ) Oral : Excellent ( )
Good ( ) Good ( )
Fair ( ) Fair ( )
**Please provide evidence of any English Language Qualifications
(e.g. score points of TOEFL/IELTS/TWE Examination) :

D. WORK EXPERIENCE (INCLUDING PRESENT JOB)

POSITION PERIOD OF NAME & ADDRESS OF RESPONSIBILITY


EMPLOYMENT EMPLOYER
FROM TO

E. OTHER QUALIFICATIONS AND MEMBERSHIPS OF PROFESSIONAL ASSOCIATIONS


(Give details of all other qualification or professional qualifications relevant to your application)

F. PUBLICATIONS
(Please attach a separate sheet, wherever necessary)

TITLE OF ARTICLE/BOOK NAME OF JOURNAL PUBLISHED BY YEAR


G. EXTRA-CURRICULAR ACTIVITIES

Extra-curricular activities in school, college and University such as membership of societies, participation in sports etc.

H. FINANCIAL SUPPORT

What will be your financial support? Will you*

a) be supporting yourself?

b) be supported by your employer?

c) be supported by any other sponsor?

If other people / organisation is paying your tuition fees and living expenses, please provide the name and address
of people / organisation and submit a letter of guarantee from your sponsor / awarding body.

I. REFEREES

Give names and addresses of two senior persons acquainted with your academic work that you have asked to write on your
behalf indicating your academic fitness and general suitability to undertake the course for which you are applying.
(i) (ii)
NAME:

OFFICE ADDRESS:

OCCUPATION/POSITION:

TELEPHONE/FAX NO.:

E-MAIL:

J. OBJECTIVE OF YOUR STUDY

Please state the reasons why you intend to pursue this course and your plans upon graduation.
K. DECLARATION

I certify that the information that I have given in this application form is correct. I agree to the condition that the
University has the right to reject this application, to withdraw the offer of admission or to terminate my study if
any information given is found to be incorrect. I also undertake to observe and ensure payment of all fees and
other liabilities.

……………………………….. …………………………………
Date Signature

1. Please complete this Application Form, enclose all the required documents in TWO SETS and send
them to:

BUSINESS AND ADVANCED TECHNOLOGY CENTRE (BATC)


UNIVERSITY TEKNOLOGI MALAYSIA, City Campus
JALAN SEMARAK, 54100 KUALA LUMPUR
MALAYSIA
or
KLIA TRAINING AND RESEARCH CENTRE SDN BHD (KTRC)
KOMPLEKS KLIA HOLDINGS, JALAN KLIA 1/70
64000 KLIA, SELANGOR DARUL EHSAN,
MALAYSIA

2. The enclosed from the referees should be completed by the referees whose names are given in Section I
of this form. Completed Referees Form duly completed should be sent directly to the above address by
the Referees. If the university does not receive the written form from your referees in time, your
application shall be considered null and void.

3. If you have been rewarded a scholarship, please attach a copy of the offer letter.

4. Incomplete application form or/and in the application is not accompanied by certified true copies of the
candidate’s Degree / Diplomas / Certificates and transcripts shall be considered null and void.

5. If you are an employee, it is your responsibility to obtain a release from the current job or a permission to
register as a postgraduate student at UTM.

6. Please attach a registration and processing fee of RM100.00 for Malaysian applicant and USD100.00 for
international applicants in either a Bank Draft or Cashier’s Order, payable to “BENDAHARI,
UNIVERSITI TEKNOLOGI MALAYSIA”.

7. The decision by the Selection Committee is final.