Personal Information

Profile photo

Full Name

Gender

Male

Female

Other

IC Number / Passport Number

Date of Birth

Nationality

Race

Religion

Date of Birth

Contact Number

Email Address

Emergency Contact Name

Emergency Contact Number

Address Information

Permanent Address

City

Postcode

State

Phone Number (if different)

Address in Home Country

City

Country

Postal Code

Program Information

Program Applied For

Program

Mode of Study

Full-Time

Part-Time

Intake

Semester

March

October

Academic Qualifications

Highest Qualification Obtained

Institution Name

Country of Institution

Year of Graduation

Result Certificate of completion studies

Previous Education

Secondary School (Name & Address)

Highest Qualification Obtained

Higher Education Institution Name

English Proficiency

English Test Taken

TOEFL

IELTS

Other (specify)

Score

Test Date

Result English

Visa Information (International Students)

Require Student Visa?

Yes

No

Type of Visa

Student Visa

Dependent Visa

Visa Expiry Date

Passport Expiry Date

Health Information

Please download the health declaration form, fill it out, and upload it here.
📄 Download Health Declaration Form

Upload Here after you fill up the health Application

Any known medical conditions?

Yes

No

Currently on any regular medication?

Yes

No

Parent/Guardian Information

Father's/Guardian's Name

Occupation

Phone Number

Mother's/Guardian's Name

Occupation

Phone Number

PAYMENT RECEIPT

After applicant make a payment for RM128.00, please upload receipt here

Declaration

I declare that the information provided is accurate.

Date

Signature of Parent/Guardian (if applicable)

Date