#### 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