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REFERENCE FORM

CONFIDENTIAL

POSTGRADUATE This Form should be used only in connection with applications for the Postgraduate Programme. The applicant should fill in his / her name and send it to the referee requesting it be completed and forwarded directly to the Institute for Postgraduate Studies (IPS). APPLICANT’S NAME

is applying to the University for admission to the Postgraduate Programme. It would be of great assistance in considering the application if you would kindly complete this form. Any information, which you give will be treated as strictly confidential.

REFERENCE 1.

How long have you known the applicant and what is your relation to him / her?

2.

How do you rate his / her academic ability? If he / she is about to take further examinations, what results do you think will be achieved?

3.

Taking an overall view, what do you consider to be the applicant’s major talents and most significant weaknesses?


4. In which category would you place the applicant in relation to the group in which you know him/her?

Outstanding

Very Good

Good

Average or below

Unable to assess

Intellectual ability Capacity for original thought, e.g. ability to initiate new ideas Organisational ability: e.g. ability to work with others, leadership qualities

5.

Please feel free, either in the following space or in a separate sheet, to make any further comments which you think will be helpful

6.

How strong do you support this application? Please tick in the appropriate box) Strongly recommended Recommended Recommended with reservations Do not recommend

Your assistance in providing this information about the applicant is greatly appreciated. Name of referee: _______________________________

Signature of referee: _____________________________

Position: ______________________________________

Date : _______________________________

Address____________________________________________________________________________________________ ___________________________________________________________________________________________________ e-mail _____________________________________________________________________________________________ Institute for Postgraduate Studies (IPS) Multimedia University Jalan Multimedia, 63100 Cyberjaya, Selangor D. E, MALAYSIA Tel: 03-83125276/5292 Fax: 03-83125300

Institute for Postgraduate Studies (IPS) Multimedia University Jalan Ayer Keroh Lama, 75450 Melaka, MALAYSIA Tel: 06-2523564 Fax: 06-2317141


REFERENCE FORM

CONFIDENTIAL

POSTGRADUATE This Form should be used only in connection with applications for the Postgraduate Programme. The applicant should fill in his / her name and send it to the referee requesting it be completed and forwarded directly to the Institute for Postgraduate Studies (IPS). APPLICANT’S NAME

is applying to the University for admission to the Postgraduate Programme. It would be of great assistance in considering the application if you would kindly complete this form. Any information, which you give will be treated as strictly confidential.

REFERENCE 1.

How long have you known the applicant and what is your relation with him / her?

2.

How do you rate his / her academic ability? If he / she is about to take further examinations, what results do you think will be achieved.

3.

Taking an overall view, what do you consider to be the applicant’s major talents and most significant weaknesses?


4.

In which category would you place the applicant in relation to the group in which you know him/her?

Outstanding

Very Good

Good

Average or below

Unable to assess

Intellectual ability Capacity for original thought, e.g. ability to initiate new ideas Organisational ability: e.g. ability to work with others, leadership qualities

5.

Please feel free, either in the following space or in a separate sheet, to make any further comments which you think will be helpful

6.

How strong do you support this application? Please tick in the appropriate box) Strongly recommended Recommended Recommended with reservations Do not recommend

Your assistance in providing this information about the applicant is greatly appreciated. Name of referee: _______________________________

Signature of referee: _____________________________

Position: ______________________________________

Date : _______________________________

Address____________________________________________________________________________________________ ___________________________________________________________________________________________________ e-mail _____________________________________________________________________________________________ Institute for Postgraduate Studies (IPS) Multimedia University Jalan Multimedia, 63100 Cyberjaya, Selangor D. E., MALAYSIA Tel: 03-83125276/5292 Fax: 03-83125300

Institute for Postgraduate Studies (IPS) Multimedia University Jalan Ayer Keroh Lama, 75450 Melaka, MALAYSIA Tel: 06-2523564 Fax: 06-2317141


Financial Guarantee Form

I agree to be the Guarantor of the student named: …………………….………………………………… Passport/ IC No:……………………… during the period of the course ………………………………………… (Name of the Course) at Multimedia University, Jalan Multimedia, 63100 Cyberjaya, Selangor or Multimedia University, Jalan Ayer Keroh Lama, 75450 Melaka, (delete where appropriate) Malaysia. If he/she leaves the University, I guarantee that I shall pay all debts incurred by this student to the Multimedia University. With this, I guarantee that in the period of his/her studies, the student concerned will abide by the constitution of the university regulations. If he/she is found to have committed any offence, I shall pay compensation of fines as required by the Multimedia University or any Court of Law. My personal particulars are as follows: (a)

Name:

:……………………………………………………

(b)

Passport No./ IC No

:.....………………………………………………….

(c)

Occupation/ Post

:…………………………………………………...

(d)

Employer

: …………………………………………………..

(e)

Office/ Employer’s Address

:………………………………………………….

(f)

Office Telephone No.

:…………………………………………………...

(g)

Home Address

:……………………………………………………..

(h)

House Telephone No.: ………………………………………………………

(i)

Monthly salary

:……………………………………….(basic)

I swear that all information given above is correct and true. Yours faithfully,

…………………………. Guarantor’s Signature

Date: ……………………..

Postal Address …………………………………… …………………………………… …………………………………….

Permanent Address …………………………………… …………………………………… …………………………………….

Note: Those qualified to be guarantors: 1. Family member/individual whose job is permanent and has a net income of not less than RM2000.00 (USD667.00) a month 2. Financial institution, such as banks and other government organisations


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