A. Personal Particulars

Campus:
Faculty:
Salutation:
Name
(as per IC / Passport for foreign student)
IC Number (New): (old):
Passport Number: (for foreign student)
Sex:
Date of birth: Place fo birth:
Race: Religion:
Nationality: Marital Status:

B. Contact Particulars

Permanent Address
Complete Address:
Postcode:
Town:
State:
Country:
Tel No: Fax No:
Mobile No: Email:
Office No:
Residential / Correspondence Address (leave blank if the same as Permanent Address)
Complete Address:
Postcode:
Town:
State:
Country:
Tel No: Fax No:
Mobile No: Email:
Office No:

C. Family Member Particulars

Parent's Name: Relationship:
Occupation:
Office Information:
Parent's Office Address:
Postcode: Tel No:
Residential Information:
Same as:
Parent's Residential Address:    
Postcode: Tel No:
Brother(s) / Sister(s)
Name Relationship Date of Birth School / Company

D. Emergency Contact Particulars

1st Contact
Name:
Same as:
Complete Address:
Tel No: Email:
Relationship: Mobile No:
2nd Contact
Name:
Same as:
Complete Address:
Tel No: Email:
Relationship: Mobile No:

E. Medical History

Major illness / disability / handicap:
Medication:
Blood Group: Blood Donor No:
Family Doctor Name:
Clinic Address:
Clinic Postcode: Clinic Tel No:

F. Latest Qualification

University / College / Institute / School Name of Award Year Award / Grade

All applicants / students must attach 3 certified true copies of the latest certificates, diplomas and degrees and provide proof of membership of professional bodies (can be certified by Principals / Registrar Office).

Document 1:
Document 2:
Document 3:

G. Employment History / Working Experience (if any)

Employer Name Position Year From Year To Duties / Experiences

* All Graduate Applicants must complete this section. Please attacth the most recent job details if possible.

Document:

H. General

Hobbies:
Special Abilities:
Remarks:
I was introduced to the college / course through:


I. Financial Support

Please provide full details of financial support:

J. Referees (For all Graduate applications only)

All Graduate applications are required to nominate two referees in support of their application. If possible one referee should be nominated from your tertiary institution or from an employer. It is your responsibility to ensure that references are sent to us by your referees on the forms provided. Please take note that both referees should be persons of good standing who are in a position to provide helpful comments about you.

  1st Referee 2nd Referee
Name:
Contact Address:
Tel No:
Email:

K. Declaration

I declare that to the best of my knowledge the information in this form is correct and complete. I understand that if I provide incorrect information this may result in my ineligibility for admission and / or enrolment. I also recognize that it is my responsibility to provide all necessary supporting documentary evidence. I recognized that all information provided, results as a property of the College. I authorize the college / its representative to obtain / release official records with respect to my application to / from the appropriate education institution(s) and other related bodies / organizations / activities / campaigns.