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Universiti Tunku Abdul Rahman Form Title : Application Form for Undergraduate and Postgraduate Non-Graduating Modular Programmes Form Number:FM-CEE-IPSR-NGMP-001

Rev No:1

Effective Date:26/06/2012

Page No.: 1 of 4

UNIVERSITI TUNKU ABDUL RAHMAN Wholly Owned by UTAR Education Foundation (Co. No. 578227 – M)

Ref No.

CEE/IPSR/NGMP/__/__

Centre for Extension Education and Institute of Postgraduate Studies and Research

(For office use only)

Application to Attend Undergraduate and Postgraduate Non-Graduating Modular Programmes Disclaimer All certificates awarded for Non-Graduating Modular Programmes will not entitle the award recipients any unit exemption nor credit transfer to UTAR’s Foundation, Undergraduate and Postgraduate Programmes .

Please complete All sections in BLOCK LETTERS and tick (√) appropriate boxes.

I. Personal Information

Affix recent passport-sized colour photograph here

Name (as in NRIC/ Passport)

NRIC No.

Gender

(for Malaysian applicant)

Passport No.

Expiry Date

(for International applicant)

(Day/Month /Year)

Nationality

Date of Birth

Correspondence Address Permanent Home Address Contact No.

Mobile No.

Male / Female *

(Day/Month /Year)

(Residence)

E-mail Address * - Delete where not relevant 1. For Undergraduate Programme, fill in Part II 2. For Postgraduate Programme, fill in Part III

II. Subject(s) that you wish to register (For Undergraduate Programme) (Please visit www.utar.edu.my/cee/ for more details on the subjects offered)

No.

Academic Programme

Unit Description

Examination Yes No

1.





2.





3.





4.





Intake : -

January

May

October

Year: __________

Participants would be awarded Certificate of Attendance for non-examination mode and Certificate of Achievement plus transcript for examination mode

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Universiti Tunku Abdul Rahman Form Title : Application Form for Undergraduate and Postgraduate Non-Graduating Modular Programmes Form Number:FM-CEE-IPSR-NGMP-001

Rev No:1

Effective Date:26/06/2012

Page No.: 2 of 4

III. Subject(s) that you wish to register (For Postgraduate Programme) (Please visit www.utar.edu.my/ipsr/ for more details on the subjects offered)

No.

Unit Code

Credit Hours

Unit Description

1. 2. 3. 4. Intake :

January

May

October

Year: ___________

Payment of Fees: (i) Tuition fee** : ______ (No. of credit hours) x RM________ (Rate per credit hour) = RM ________ (** to be paid upon approval of application. By Bankdraft /Banker’s cheque made payable to “Universiti Tunku Abdul Rahman”)

(ii) Administrative fees: RM100.00 per subject (Non-refundable. Must be submitted together with application form) -

Participants will not be required to sit for examination at the end of the course. Certificate of Attendance will be awarded to participants who has successfully completed the course. Malaysian Candidates (RM)

International Candidates (RM)

1) Master of Arts (Chinese Studies)

305.00 per credit hour

366.00 per credit hour

2) Other Master’s Degree Courses

405.00 per credit hour

486.00 per credit hour

Tuition Fee Master’s Degree Technical Unit in

IV. Academic & Professional Qualification Qualification:

Professional Qualification / Membership:

V. Working Experience (Please state your recent employment)

Month and Year From To

Name and Address of Employer

2

Nature of Work and Position Held

Universiti Tunku Abdul Rahman Form Title : Application Form for Undergraduate and Postgraduate Non-Graduating Modular Programmes Form Number:FM-CEE-IPSR-NGMP-001

Rev No:1

Effective Date:26/06/2012

VI. Immigration Visa 1. Holding any type of Malaysian Visa now? 2. If “Yes”, the type of Visa:

Yes

Social visit

Page No.: 3 of 4

(For International applicant only)

No

Student

Diplomatic

Dependent

Visa No. : ________________________________ Expiry date: _______________________ 3.

If you are currently or were formerly a student of another University/College/Institute in Malaysia: Name of the University/College/Institute: _________________________________________________

Programme/Course: _________________________________________________________________ Date of Joining: ____________________________

Date of Leaving: _______________________

* Personal data collected will be protected in accordance to Personal Data Protection Act 2010.

VII. Declaration by Applicant I hereby declare that the information provided by me in this application is true and correct. I agree to abide by all terms and conditions stated in the University Guidelines, Policies, Regulations and Rules. I understand and accept that Universiti Tunku Abdul Rahman reserves the right to withdraw the offer of admission or ask me to leave the University, if at any time I am found to be in breach of the aforesaid terms and conditions or that the information provided by me is found to be false or incorrect.

__________________

_____________________

Name of Applicant

Signature of Applicant

______________ Date

VIII. Fee Payment* Details For Office Use Only:

Course Fee Class Allocation

RM____x___

Payment Date

Receipt No.

RM____x___

Payment Date

Receipt No.

Day :

Time :

Venue :

Staff In charge Remarks:

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Universiti Tunku Abdul Rahman Form Title : Application Form for Undergraduate and Postgraduate Non-Graduating Modular Programmes Form Number:FM-CEE-IPSR-NGMP-001

Rev No:1

Effective Date:26/06/2012

Page No.: 4 of 4

*Terms and Conditions 1. 2. 3. 4. 5.

Registrations must be accompanied with payment. Fees paid are not refundable nor transferable. Confirmation of registration is upon receipt of payment. The programme schedules are subject to change. The University reserves the right to cancel or postpone, make amendments and/or changes to the programme if warranted by circumstances beyond its control.

IX. Recommendation / Approval Dean’s Recommendation:

Director of Centre for Extension Education (CEE) / Director of Institute of Postgraduate Studies and Research (IPSR):

Recommended / Not Recommended*

Application approved / Not approved*

Remarks:

Remarks:

Signature of Dean of Faculty:_____________

Signature of Director of CEE / IPSR*:_______________

Date

:_____________ Date

:_______________

Dean’s stamp

:_____________ Director’s stamp

:_______________

* - Delete where not relevant

X. Checklist Submit completed application form together with the following:

(i)

Photocopy of Identity Card (front and back) - for Malaysian applicant Photocopy of your passport (all printed pages of the passport) - for International applicant

(ii)

A self-addressed envelope, measuring 7” x 10” affixed with RM1.50 stamp – for postgraduate programme

(iii)

Payment can be made by Money/Postal Order/Bankdraft or Banker’s cheque / Personal cheque (where drawee bank is in Malaysia) made payable to “Universiti Tunku Abdul Rahman”.

(iv)

Send the completed application form and all items stated above to: UTAR, Sungai Long Campus (For Undergraduate Programme) Jalan Sungai Long, Bandar Sungai Long, Cheras, 43000 Kajang, Selangor Darul Ehsan Tel: (603) 03-9019 8088 (Direct Line) Fax: (603) 9019 3880 Mobile: (016) 223 3563 UTAR, Kampar Campus (For Undergraduate Programme) Heritage Hall, First Floor, Jalan Universiti, Bandar Barat, 31900 Kampar, Perak Tel: (605) 468 8888 ext: 2236 Fax: (605) 466 7796 Or Institute of Postgraduate Studies and Research (For Postgraduate Programme) UTAR, Jalan Sungai Long, Bandar Sungai Long, Cheras, 43000 Kajang, Selangor Darul Ehsan

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