Revision: February 2023

RECENT PASSPORT
PHOTO

STUDENT EXCHANGE PROGRAMME (INBOUND)

APPLICATION FORM
INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA (IIUM)

1. PERSONAL INFORMATION
Name :

Gender : Male / Female Marital Status : Single / Married

Date of Birth :

Passport Num. : Valid until :

Religion : Mazhab :

Citizenship :

Country of Origin :

Country of Residence :

Mobile Num. :+

Email Address :

Permanent Address :

Postcode : Country :

2. 2EMERGENCY CONTACT NUMBER

Name :

Relationship :

Mobile Num. :+

Email Address :

Occupation :

Home Address :

Postcode : Country/State :

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3. ACADEMIC BACKGROUND AT HOME UNIVERSITY

Home University :
∕ of Education
Level : Diploma / Degree / Master / PhD

Name of Programme :

Name of Faculty :

Current Semester : 1st / 2nd / 3rd / 4th / 5th / 6th/ 7th/ 8th/ 9th/ 10th

Current Year : 1st / 2nd / 3rd / 4th / 5th/ 6th

Current Result (CGPA) :

Research Tittle :
(for postgraduate)

Does your university have MoU/MoA with IIUM : Yes No

4. LANGUAGE PROFICIENCY
Please tick (/) where applicable:

Is English your first/main language : Yes No

If no, please indicate any English Language Proficiency Test you have taken and the result.

TOEFL :

IELTS :

Others :

 Please provide a certified copy TOEFL/IELTS/other test to demonstrate English proficiency

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5. PROPOSED STUDY IN IIUM

Type of Programme : Exchange Programme (1 or 2 semesters with credit transfer)

Erasmus Exchange Programme

Mevlana Exchange Programme

Research Programme

Internship Programme

Short Visiting Programme

Summer Programme

University Mobility in Asia and the Pacific (UMAP) Programme

Others, please specify:

Type of Mobility : Physical Virtual

Kulliyyah Applied :

Duration of Study : Semester 1 (October – February)

Semester 2 (March – July)

Semester 3 (August – September)

One Year ( to )

Transfer of Credit Hours: Yes No

Research Tittle :
(for postgraduate)

6. PROPOSED COURSES OF STUDY AT IIUM

Name of Kulliyyah :

Programme :

No. Course Code Course Name Credit

1
2

3
4
5
6

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7. ACCOMMODATION

On Campus : Main campus, IIUM Gombak Off Campus : No

Kuantan Campus, IIUM Kuantan

Pagoh Campus, IIUM Pagoh

No. Type of Room Rate (RM)

1
Single Room (for Postgraduate Student) RM360 / month (include electricity)
2 Quad Room (for Undergraduate Student)
RM165 / month (include electricity)
• 4 People

*Note: This is only for Gombak Campus. For Kuantan and Pagoh campus, please refer to the respective
kulliyyah.

8. FINANCIAL DETAILS
Who will be paying your fees and providing fund for living expenses?

Self-sponsor

Scholarship

Sponsor Name :

Amount :

Others

Please specify :

9. APPROVAL FROM THE INTERNATIONAL OFFICE (HOME UNIVERSITY)

I hereby certify that this student is qualified and recommended in joining the above program at International
Islamic University Malaysia (IIUM) as per duration stated.

Stamp:
Name :

Position :

Email Address :

Mobile Num. :

Date :

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10. STUDENT DECLARATION

I declare that all the information provided in this application form is true and complete in every detail. I
acknowledge that (International Islamic University Malaysia IIUM) reserves the right to vary or reverse any
decision regarding admission or enrolment made on the basis of incorrect or incomplete information. I am
aware of the conditions relating to my application and admission and agree to pay all fees for which I am
liable to.

Name :

Date :

11. RECOMMENDATION FROM OFFICE OF INTERNATIONAL AFFAIRS, IIUM

Recommended Not Recommended

Director/Assistant Director Sign & Stamp: Date:

12. APPROVAL FROM KULLIYYAH/FACULTY

Approved Rejected

Dean/Deputy Dean of Academic Sign & Stamp: Date:

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13. APPLICATION CHECKLIST

I hereby submit this application for the IIUM Student Exchange Program (inbound) and attached all the
following compulsory documents in support of the information provided:

Scanned of passport information page

One copy of latest passport photo (paste on the right corner of 1st page)

Latest certified academic transcript (in English translation)

Confirmation letter from home university (to prove the applicant is enrolled as a full-time student)

Official letter of sponsorship

Receipt payment of processing fee (100 USD). Applicable for Non-partner university only:

IIUM Operating Account : 1407-0000004-71-6

Bank : Bank Muamalat Malaysia Berhad
Swift Code : BMMBMYKL
Beneficiary : International Islamic University Malaysia

Application Deadline: 31st May (Semester 1 – October to February)

31st October (Semester 2 – March to July)
31st March (Semester 3 – August to September)

Kindly submit your application and supporting documents by EMAIL to:

Office of International Affairs, IIUM

Email : iceo@iium.edu.my
Phone No: +603-6421 5774/5775

NOTE: Incomplete application form will not be processed and any LATE application will not be entertained.

FOR IO OFFICE USE ONLY

Application Status : Accepted Rejected Withdraw

Kulliyyah :

Programme : Stamp:

Type of Mobility :

Name of Officer
Received :

Position :

Date Received :

Signature :

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