Intake Date

Matric No.

APPLICATION FOR ADMISSION PERMOHONAN KEMASUKAN

All sections of the form must be completed. Semua bahagian borang mesti diisi. USE CAPITAL LETTERS

GUNAKAN HURUF BESAR

Programme Applied For / Program Dipohon Venue / Lokasi

Name of Applicant / Nama Pemohon

Full Name (as per IC) / Nama Penuh (mengikut K.P):

No. Application Checklist / Senarai Semak Permohonan 1. One copy of I.C.

Kepilkan satu salinan kad pengenalan

2. One certified copy of all academic certificates and transcript. Kepilkan satu salinan sijil akademik dan transkrip yang disahkan

3. TWO (2) passport sized photo. One photo to be attached to the application form. Please write your name and I.C number at the back of the photo. DUA (2) gambar bersaiz pasport. Satu gambar dilekatkan pada borang. Sila tulis nama dan K.P dibelakang gambar.

4. Confirmation letter from current employer. Lampirkan surat pengesahan dari majikan

5. EPF Statement (for candidates who wish to withdraw from EPF). Penyata KWSP (bagi pemohon yang ingin membayar dari akaun KWSP)

6. Application fee of RM200.00 (non-refundable) in the form of bank draft / money order / postal order made payable to METEOR LEARNING SDN BHD. Yuran permohonan RM 200.00 (tidak dipulangkan) dalam bentuk bank draf / kiriman wang / kiriman pos di atas nama METEOR LEARNING SDN BHD

7. Select T-Shirt Size / Pilih saiz T-shirt S M L XL XXL For office use only Account Dept Programme Management Registry Received by: ___________________ Receipt No : ___________________

Approved by : ________________ Category :

Data entry by : ________________

A OL, EPF

B OL, EPF, SS

C OL

Date : Date : Date :

Please glue one passport sized photo here/ Lekat satu gambar bersaiz passport di sini

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1. PERSONAL DETAILS / BUTIR-BUTIR PERIBADI

I.C. /Passport Number / No. K.P / Pasport : Nationality / Warganegara :

Date of Birth / Tarikh Lahir : Race / Bangsa :

Status : Gender / Jantina : Married / Berkahwin Single / Bujang Male / Lelaki Female / Perempuan

Home Address / Alamat Rumah :

Correspondence Address (current) / Alamat surat menyurat :

Postcode :

Postcode :

Home Phone Number / Telefon Rumah : Office Telephone Number / Telefon Pejabat :

H/P Number / Telefon Bimbit : Fax Number / Nombor Faks :

E-mail : 2. EDUCATION BACKGROUND / LATAR BELAKANG PENDIDIKAN

Name of University / College / School

Nama Universiti / Kolej / Sekolah Qualification Awarded

Kelayakan Diterima Year

Tahun Specialisation Pengkhususan

3. EMPLOYMENT BACKGROUND / LATAR BELAKANG PEKERJAAN

Title of Job / Position Held (recent first) Jawatan Dipegang (Dahulukan yang terkini)

Name of Organisation Nama Organisasi

Employment Date (Start-End) Tarikh Pekerjaan (Mula - Tamat)

4. SPECIAL CIRCUMSTANCES / KEADAAN KHAS

Do you have any disability, impairment or long-term medical condition which may affect your studies? Adakah anda mempunyai sebarang masalah kesihatan atau rintangan fizikal yang mungkin akan memberi kesan kepada pembelajaran anda?

Yes / Ya No / Tidak

If you do, please provide extra information / Sekiranya ya, sila beri maklumat lanjut 5. FINANCIAL SUPPORT / SOKONGAN KEWANGAN

How do you plan to support your studies / Bagaimana anda menyokong pengajian anda dari segi kewangan

Source / Sumber Please Tick / Sila tandakan ()

Personal Finance / Kewangan Peribadi

Scholarship / Biasiswa

EPF / KWSP

Bank loans / Pinjaman bank

Others (please specify) / Lain-lain (nyatakan)

6. EMERGENCY CONTACTS / KECEMASAN

(i) Relative / Keluarga (ii) Others / Lain-lain

Name/Nama : Name/Nama : __________________________________ Relationship : Relationship : Hubungan : Hubungan :Telephone : Telephone : Telefon : Telefon :H/P No : H/P No : Tel. Bimbit : Tel. Bimbit : 7. ACKNOWLEDGEMENT CARD / KAD MAKLUMAN Please fill in your name and address and affix a RM0.30 stamp on the card. Sila isikan nama dan alamat anda serta lekatkan setem RM0.30 pada kad.

Affix stamp here (RM

0.30)

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8. OTHER INFORMATION / MAKLUMAT LAIN How did you find out about this programme? / Bagaimana anda mendapat tahu mengenai program ini?

Please Tick / Sila tandakan ( )

Friends / Kawan-kawan

Family / Keluarga Newspapers (please specify) / Surat khabar (nyatakan) Education fair / preview (please specify) / Ekspo Pendidikan / Prebiu (nyatakan)

Others (please specify) / Lain-lain (nyatakan)

Please explain why you applied for the above programme. How can this programme assist you in your career development? / Sila jelaskan mengapa anda memohon program ini. Bagaimana program ini dapat membantu anda dalam perkembangan kerjaya anda?

9. DECLARATION AND SIGNATURE / PENGESAHAN DAN TANDATANGAN

I declare that the information provided by me in this application form is true and correct. I acknowledge that IPD-OUM reserves the right to vary or reserves any decision regarding admission or enrolment made regarding the basis of incorrect or incomplete information. Saya mengesahkan bahawa semua maklumat dalam borang ini adalah sahih dan benar. Saya bersetuju bahawa IPD-OUM berhak untuk mengubah keputusan berkenaan kemasukan sekiranya maklumat yang saya berikan adalah tidak benar atau tidak lengkap.

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Signature of Applicant Date: Tandatangan Pemohon Tarikh:

For office use only

Dear Sir/Madam, Date:

ADMISSION STATUS

We have received your application. Thank you for your interest in our programme.

Your application is being processed

Your application is successful: We will notify you of the registration date soon* The registration date is ________________

Your application is incomplete. Please send the following document(s):

Copy of Identity Card or Passport

Copy of PMR (SRP/LCE) / SPM/SPMV (MCE) / STPM (HSC) / Diploma

Confirmation / Referral Letter from employer

Two (2) passport sized photos

Institute of Professional Development METEOR House Open University Malaysia *Registration/class will commence upon achieving minimum of 20 students Jalan Tun Ismail, 50480 Kuala Lumpur. (Attn : Admission Unit) Tel : 03-2773 2000 / 2535 / 2536 Fax : 03-2697 8790 / 8791