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Form Contents
First Name *
Last Name *
Email Address *
Telephone *
Date of Birth *
Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Age *
-- Please Select -- Under 15 16 - 19 20 - 25 26 - 35 36 - 45 46 - 60 Over 60
Nationality
Afghanistan ?land Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Democratic Republic of the Congo Cook Islands Costa Rica C?te d'Ivoire (Ivory Coast) Croatia Cuba Cura?ao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Former Yugoslav Republic of Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Federated States of Micronesia Republic of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-Leste (East Timor) Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam British Virgin Islands U.S. Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
State (for Malaysian only)
Not applicable Johor Kedah Malacca Negeri Sembilan Pahang Perak Perlis Penang Sabah Sarawak Selangor Terengganu W.P Kuala Lumpur W.P Labuan W.P Putrajaya What is your highest academic level? * -- Please Select -- Year 12 - Form 6 / A-Levels / STPM / UEC / Pre-U / Foundation / Matriculation / Grade 12 Year 11 - Form 5 / O Levels / SPM / Grade 11 Diploma holder Degree Master PHd Others Your preferred intake * -- Please Select -- October 2020 February 2021 July 2021 October 2021 Others Your preferred level of study * -- Please Select -- Undergraduate Postgraduate PHd/Research
Enquire on course of study *
-- Please Select -- Arts - Bachelor of Arts and Social Sciences Arts - Bachelor of Digital Media and Communication Arts - Bachelor of Arts (Honours) Arts - Master of Communications and Media Studies Arts - Master of Arts Arts - Doctor of Philosophy (PhD) Business - Bachelor of Business and Commerce Business - Bachelor of Business and Commerce (Honours) Business - Bachelor of Business and Commerce and Bachelor of Digital Media and Communication Business - Postgraduate Diploma in Business and Commerce Business - Master of International Business Business - Master of Philosophy Business - Doctor of Philosophy (PhD) Engineering - Bachelor of Civil Engineering (Honours) Engineering - Bachelor of Chemical Engineering (Honours) Engineering - Bachelor of Electrical and Computer Systems Engineering (Honours) Engineering - Bachelor of Mechanical Engineering (Honours) Engineering - Bachelor of Robotics and Mechatronics Engineering (Honours) Engineering - Bachelor of Software Engineering (Honours) Engineering - Master of Engineering Science (Research) Engineering - Doctor of Philosophy (PhD) IT - Bachelor of Computer Science IT - Bachelor of Computer Science in Data Science IT - Master of Business Information Systems IT - Master of Philosophy IT - Doctor of Philosophy (PhD) Medicine - Bachelor of Medicine Science and Doctor of Medicine (BMedSc/MD) Medicine - Bachelor of Medical Science (Honours) Medicine - Bachelor of Psychological Science Medicine - Bachelor of Psychological Science and Business Medicine - Bachelor of Psychological Science and Business (Psychology) (Honours) Medicine - Master of Biomedical Science Medicine - Master of Professional Counselling Medicine - Postgraduate Diploma in Biomedical Science Medicine - Doctor of Philosophy (PhD) Pharmacy - Bachelor of Pharmacy (Honours) Science - Bachelor of Science Science - Bachelor of Medical Bioscience Science - Bachelor of Food Science and Technology Science - Bachelor of Science (Honours) Science - Master of Science Science - Doctor of Philosophy Others
Questions and comments
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