1 Hak Milik SPS

Reference

No.

UTM(NGS)-01/05 SCHOOL OF GRADUATE STUDIES

UNIVERSITI TEKNOLOGI MALAYSIA 81310 UTM SKUDAI, JOHOR

TELEPHONE: (+6) 07-553 7898/553 7904 FAX: (+6) 07-553 7592

APPLICATION FOR ADMISSION TO A POSTGRADUATE

PROGRAMME (NON-GRADUATING STUDENT) SESSION* ______________ SEMESTER* I (SEPTEMBER) / II

(FEBRUARY)

AFFIX RECENT

PASSPORT SIZED

PHOTOGRAPH

A. PERSONAL DATA

Full Name As In Passport/Identity Card (IN BLOCK LETTERS)

Correspondence Address:

Telephone: Mobile Phone: E-mail :

Country of Origin: Date of Birth: (Day/Month/Year) Passport No.:

Nationality: Sex: Religion:

Marital Status: Number of Dependents:

B. PARENT UNIVERSITY

C. HOSTING UNIVERSITY*

Level of Study: Master Doctoral

Name of Programme: Faculty :

Nature of Study: Taught Course Taught Course & Research Research

Field of Study / Title of Research (for programme by research - please enclose your research proposal):

Name of Supervisor (Hosting University) :

PARENT INSTITUTION

(name of university, department & name of

supervisor) I

NAME OF PROGRAMME

DURATION OF STUDY

DATE OF ENROLMENT

EXPECTED DATE OF GRADUATION

2 Hak Milik SPS

D. FINANCIAL SUPPORT

What will be your financial support? Will you*

a) be self-sponsored?

b) be supported by any sponsor? Vote Number :

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.

Name of Research Leader :

Address :

E. SUPERVISORS

Indicate the name and address of supervisors supervising your current research / course

DETAILS PARENT UNIVERSITY HOSTING UNIVERSITY

NAME:

OFFICE ADDRESS:

(DEPARTMENT / UNIVERSITY)

Faculty of

Universiti Teknologi Malaysia

Skudai, Johor

POSITION:

TELEPHONE/FAX NO.:

E-MAIL:

SIGNATURE :

F. 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

FOR OFFICE USE ONLY

Programme Code :

Duration of Offer :

Faculty :

Passport Num :

Approved By : Date :

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