Borang permohonan

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Borang permohonan

  1. 1. BB 02-01 KOLEJ UNIVERSITI ISLAM MELAKA University College of Islam Melaka (Milik Penuh Kerajaan Negeri Melaka) Wholly Own By State Government of MelakaBORANG PERMOHONAN PELAJAR Untuk Kegunaan Unit Kemasukan dan RekodStudent Application FormSila gunakan Huruf Besar (Please write in block letters) Untuk Kegunaan PejabatSila isi di ruang yang telah disediakan (Please complete all registration form)PILIHAN PERTAMAFirst ChoicePILIHAN KEDUASecond ChoicePILIHAN KETIGAThird ChoiceA. MAKLUMAT PERIBADI (Personal Information) NAMA / Name : ALAMAT / Address : POSKOD / Postcode : NO K/P / I /C No. : - - NEGERI / State : PELAJAR ANTARABANGSA / For International Student Only Passport No : Bujang/ Single BANGSA / Race : STATUS / Status : Berkahwin/ Married WARGANEGARA/ : Nationality UMUR / Age : H/P: NO. TELEFON / Telephone no. : B. KEPUTUSAN PEPERIKSAAN SPM/STPM Examination Result Ordinary Level (O Level) GRED GRED BIL. MATA PELAJARAN (Subject) BIL. MATA PELAJARAN (Subject) (Grade) (Grade) 1. BAHASA MELAYU 6. 2. BAHASA INGGERIS English 7. 3. MATEMATIK Mathematics 8. 4. PENDIDIKAN ISLAM Islamic Studies 9. 5. SAINS Science 10UNTUK PERMOHONAN PROGRAM IJAZAH/ IJAZAH SARJANA MUDA (Master/Degree program Application)C. KEPUTUSAN DIPLOMA/ MATRIKULASI/ PROGRAM ASASI/ STAM Matriculation/ Foundation /STAM ResultDIPLOMA/ MATRIKULASI/ ASASI/ NAMA DIPLOMA & INSTITUSI GRED/ CGPA/ MUETSTAM (Diploma & Institute) PANGKAT (TAHAP/(Matriculation/ Foundation /STAM) (Grade/ CGPA) Band) Semakan C Unit kemasukan dan rekod KUIM 2011
  2. 2. Saya mengaku bahawa semua maklumat yang diberikan adalah benar. Pihak Kolej Universiti Islam Melaka (KUIM) berhak menolak permohonanini sekiranya pada bila-bila masa didapati mana-mana maklumat adalah tidak benar/ palsu.I hereby confirm that the information that I have provide in this form is true and complete. I understand that University College of Islam Melaka may vary orreverse any decision regarding admission or enrollment made on the basis of incomplete information provided by me. I authorize University College of IslamMelaka to make enquiries about the detail associated with this application. Hantarkan permohonan anda ke/ Send your application to: KOLEJ UNIVERSITI ISLAM MELAKA KUALA SUNGAI BARU, 78200 MELAKA, MALAYSIA ……………………………………... …………………………… (U/P: UNIT KEMASUKAN DAN REKOD) Tandatangan / Signature Tarikh / Date TEL: 06-3878382/3878420/3878417 FAKS: 063878368/3878411 Laman Web http://www.kuim.edu.my SENARAI SEMAK / Check list Sertakan bersama salinan keputusan SPM/STAM/O Level/ Salinan Transkrip dan Salinan Kad Pengenalan yang telah disahkan benar. Please attach copy of SPM/STPM/ O Level result/ diploma transcript and International passport of equivalent. (International Student).

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