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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

To all applicants Thank you for choosing Universiti Utara Malaysia as your centre for excellence. Please read the admission requirements carefully before filling up the APPLICATION FORM and ensure all information provided is accurate before submitting the form. While filling in the form, please pay attention to the following: • Fill in the form in block letters using a black pen or a typewriter; • All sections must be filled in. State “not applicable” wherever necessary. Your application must include the following:

1.

Application form completed for all sections, signed and attached with recent passport-sized colour photograph;

2.

Proof of payment for processing fee of RM100.00 (for Malaysian applicants)/ USD35.00 @ RM125.00 (for ASEAN applicants)/ USD50.00 @ RM175.00 (for NON ASEAN applicants). Payment can be made by the following method:  Online payment via e-commerce (e-com) link on the web www.uum.edu.my . Choose payment mode credit card (Mastercard/Visa) or FPX (if you are an internet banking user). Attach the printed receipt to the application form; or  at any branch of Bank Islam Malaysia Berhad (BIMB) use the Bill Payment Slip. Specify payee code 340 in the column “pay for” in the Bill Payment Slip;  Any payment from outside Malaysia can be made through Telegraph Transfer as below:  Beneficiary: Bendahari Universiti Utara Malaysia  Bank name: Bank Islam Malaysia Berhad  Account number: 02093010000010 (there are 14 digits)  Bank branch/address: Bank Islam Malaysia Berhad (BIMB) UUM Branch Universiti Utara Malaysia 06010 Sintok, Kedah Malaysia  Swift code: BIMBMYKL  Bank’s tel. no.: 604-9246271

3. 4. 5. 6.

Certified copy of Identity Card; Certified copy of your degree/diploma and official academic transcript; Certified copy of English language proficiency certificate (i.e. IELTS/TOEFL/MUET) and Professional Certificate (if any); Financial Guarantee:

a) b) 7. 8. 9.

Letter of undertaking for Scholarship/training award/study loan; OR Latest bank account statement of the applicant that has at least USD2500 for candidate from ASEAN country and USD5000 for candidate from Non-ASEAN country

Letter of approval/official leave from employer/relevant authorities to pursue this programme (if any); Copy of research proposal (for applicants doing full research only); and Documents for international applicants:  Two (2) copies of International passports (front page only) and four (4) copies of passport-sized coloured photographs; and  A release letter from other Malaysian Higher Learning Institution for Immigration purposes (for applicant who previously studied at other Malaysian Higher Learning Institution).

Please be informed that the acceptance letter will be posted through your e-mail. Only the completed form received before closing date will be processed. Please address your application to the respective Graduate School as below: Dean Awang Had Salleh Graduate School of Arts & Sciences Universiti Utara Malaysia 06010 Sintok Kedah Malaysia

Dean Othman Yeop Abdullah Graduate School of Business Universiti Utara Malaysia 06010 Sintok Kedah Malaysia

Dean Ghazali Shafie Graduate School of Government Universiti Utara Malaysia 06010 Sintok Kedah Malaysia

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

I look forward to seeing you at UUM. Thank you. Deputy Vice Chancellor Academic and International Affairs

SEMESTER:

Semester I (September Intake) Semester II (January/February Intake)

SESSION:

Please attach recent passport-size photograph here

(e.g.: 2012/2013)

INFORMATION ABOUT UUM OBTAINED FROM*: [ [ [ [

] UUM website ] Hot courses ] Educations.com ] Advertisement

[  ] Recruitment Agent • Name of Agent:

[ [ [ [ [ Ahmed Sheikh Abdullah

] Current students/staff in UUM ] Alumni UUM ] Local/overseas promotions ] UUM Off-shore Office ] Others: Please indicate: _______________________ ____________________________________

Al-Aidaroos

• Agent Registration No.: UUM / CIAC /SR / 2013-034 * Note: Please tick ( ) whichever applicable.

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PROGRAMME DETAILS Name of Programme (name one) College

Mode of Studies *: [

Programme Structure*: [

Place of Studies*: [

] Full- time

] Coursework

] UUM Sintok

[

] Part-time

[

] Coursework & Dissertation

[

[

] Research

] Branch Centre: ___________________________

* Note: Please tick ( ) whichever applicable. 2


APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

PERSONAL DETAILS

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Full Name (As per I.C./Passport): ______________________________________________________________ Identity Card No.(NRIC): _________________________

Passport No: ___________________________

Date of Birth: ____________________________

Place of Birth: __________________________

Gender*:

Age: ________________________________

[

] Male

[

Religion: _____________ Marital Status*:

[

] Female Race: _____________

] Single

[

] Married

Nationality: _______________________ [

] Widow

Permanent Address:

Mailing Address:

Postcode : _________ Town : _____________

Postcode : _________ Town : _____________

DUN**: _______________________________

PARLIAMENT**: _______________________________

Tel. No : ____________________ (H) ______________________ (O)

______________________ (H/P)

E-mail : ___________________________________________________________________________ *Note: Please tick (ď ? ) whichever applicable. **Compulsory for Malaysian applicant only

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FAMILY BACKGROUND a. Name of Spouse : ______________________________________________________________ Occupation: ______________________________ Tel. No: _____________________________ Employer's Name & Address: ____________________________________________________ _______________________________________________________________________________ Tel. No.: ________________________ No. of Children: ______________________________

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

b. Person to be notified in case of emergency: ________________________________________ Address: ______________________________________________________________________ _______________________________________________________________________________ Tel. No. : ________________________

Relationship: __________________________________

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

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EMPLOYMENT DETAIL/EXPERIENCE Current Position: _______________________________ Date Held: ________________________ Employer's Name and Address: ____________________________________________________ _________________________________________________________________________________ Tel. No.: ______________

Fax No.: ______________

E-mail: ____________________

Previous position (Working experience after obtaining First Degree, if any) Name of Position

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Employer’s name and address

From – To

Length of Service

ACADEMIC BACKGROUND Name and address of Institution

Year Attended

Diploma/Degree Obtained

Date Of Graduation

Class/CGPA

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

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PROFESSIONAL QUALIFICATION Qualification

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Year Awarded

Awarded by

ENGLISH LANGUAGE QUALIFICATION Please indicate your English Language qualification: Malaysian University English Test (MUET)

score: _________

International English Language Testing System (IELTS)

score: _________

Test of English as a Foreign Language (TOEFL)

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(

) Paper Based Test

score: _________

(

) Internet Based Test

score: _________

PROFESSIONAL PUBLICATION Title of Book/Journal

Year of Publication

Name and location of Publication

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

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FINANCIAL SUPPORT/ GUARANTEE

Please indicate your source of financial support Employer / government Study loan fund Self-support *please attach your latest bank account statement that has at least RM2500 (for Malaysian applicants) or USD5000 (for applicants from Non-ASEAN countries) or USD2500 (for applicants from ASEAN countries). Name and address of person/organization paying your fees

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ACADEMIC REFEREE (Name two [2])

The academic referees must comprise of those who know the applicant in terms of his/her academic performance [e.g.: Dean, Lecturer, Employer] and should not have any personal acquaintances or relatives

1) Name : _______________________________

2) Name : ______________________________

Address : _____________________________

Address : ___________________________

_______________________________________

_____________________________________

___________________________________

_____________________________________

Tel. No : _______________________________

Tel. No. : _____________________________

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

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FIELD OF RESEARCH (Applicant who wishes to pursue postgraduate study by full research must fill in this section)

Area of Research: ______________________________________________________________________ Proposed Research Title: ________________________________________________________________ _____________________________________________________________________________________ Aims/Objectives of Research: _____________________________________________________________ _____________________________________________________________________________________ Academic Staff whom you have met and discussed about your research, if any: _____________________________________________________________________________________ Intended research location _____________________________________________________________________________________ PLEASE ATTACH A COPY OF YOUR RESEARCH PROPOSAL

12 I hereby certify that the above information and documents enclosed is true and complete. Universiti Utara Malaysia reserves the right to reject this application if the information given is false and/or incomplete.

DECLARATION

____________________________ Applicant's Signature

________________ Date

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

REFEREE REPORT (1) This report is CONFIDENTIAL and must be sealed by the referees and forward the envelope to the applicant to be submitted together with the application form PART A : TO BE COMPLETED BY THE APPLICANT Name : __________________________________________________________________________ Programme of Studies : ____________________________________________________________ Place of Studies : ________________________________________________________________ Mode of studies * : [

] Full- time

Programme Structure : [

[

] Research [

] Part-time

[

] Coursework

] Distance Learning [

] Coursework & Thesis

PART B : TO BE COMPLETED BY THE REFEREE Name : __________________________________________________________________________ Official Position : ________________________________________________________________ Employer’s name and address: _____________________________________________________ ______________________________________________ Postcode : _______________________ Town : _______________

State: _______________

Country : _________________________

Tel. No. : ________________ Fax No. : ______________ E-mail : __________________________

a) How long have you known the applicant? ___________________________________________ b) How do you know the applicant? __________________________________________________ c) What is your relationship to the applicant? _________________________________________ d) Do you believe that the applicant is prepared for graduate work? [ ] Yes [ ] No e) What do you think are persona traits of the applicant that will enable him/her to pursue postgraduate study? _______________________________________________________________________________ _______________________________________________________________________________ * Please tick ( ) whichever appropriate

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

f) How do you rate the applicant on each of the following? Please tick whichever appropriate. Excellent i)

Intellectual ability

ii)

Maturity and emotional stability

Very Good

Good

Average

Poor

iii) Motivation

iv)

General Knowledge

v)

Initiative

vi)

Ability to cooperate

vii) Responsibility

Your Recommendation [

] Recommended

_________________________ Referee’s Signature

[

] Not recommended

_________________________ Date

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

REFEREE REPORT (2) This report is CONFIDENTIAL and must be sealed by the referees and forward the envelope to the applicant to be submitted together with the application form PART A : TO BE COMPLETED BY THE APPLICANT Name : __________________________________________________________________________ Programme of Studies : ____________________________________________________________ Place of Studies : ________________________________________________________________ Mode of studies * : [

] Full- time

Programme Structure : [

[

] Research [

] Part-time

[

] Coursework

] Distance Learning [

] Coursework & Thesis

PART B : TO BE COMPLETED BY THE REFEREE Name : __________________________________________________________________________ Official Position : ________________________________________________________________ Employer’s name and address: _____________________________________________________ ______________________________________________ Postcode : _______________________ Town : _______________

State: _______________

Country : _________________________

Tel. No. : ________________ Fax No. : ______________ E-mail : __________________________

a. How long have you known the applicant? ___________________________________________ b. How do you know the applicant? __________________________________________________ c. What is your relationship to the applicant? _________________________________________ d. Do you believe that the applicant is prepared for graduate work? [

] Yes

[

] No

e. What do you think are persona traits of the applicant that will enable him/her to pursue postgraduate study? _______________________________________________________________________________ _______________________________________________________________________________ * Please tick ( ) whichever appropriate 12


APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

f) How do you rate the applicant on each of the following? Please tick whichever appropriate. Excellent

i.

Intellectual ability

ii.

Maturity and emotional stability

iii.

Motivation

iv.

General Knowledge

v. vi. vii.

Very Good

Good

Average

Poor

Initiative

Ability to cooperate

Responsibility

Your Recommendation [

] Recommended

_________________________ Referee’s Signature

[

] Not recommended

_________________________ Date

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APPLICATION FOR POSTGRADUATE STUDIES PROGRAMME

APPLICATION CHECK LIST Please tick  in the column for the documents which are enclosed No.

Tick 

Documents required

1.

Proof of payment for processing fee payable to “Bendahari UUM”

2.

Complete and signed application form

3.

Two (2) copies of recent colour photographs, and one is fixed to the application form

4.

Certified copies of degree/equivalent qualifications, MUET/TOEFL/IELTS, and professional certificates.

5.

Certified copy of Identity Card

6.

Two (2) copies of referee form from two (2) referees.

7.

Financial Guarantee:  Letter of undertaking for Scholarship/training award/study loan; OR  Latest bank account statement of the applicant that has at least USD2500 for candidate from ASEAN country and USD5000 for candidate from Non-ASEAN country

8.

A copy of your research proposal for applicants doing full research only (1,000 – 1,500 words for the masters, and 1,500 – 2,000 words for Ph.D).

9.

Two (2) copies of international passport (front page only) and four (4) copies of passportsized coloured photographs (for international applicant only).

10.

A release letter from other Malaysian Higher Learning Institution for Immigration purposes (for international applicant who has studied at other Malaysian Higher Learning Institution)

full

academic

transcripts,

NAME

PROGRAMME

COLLEGE

SIGNATURE

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Postgraduate application form new 30102012  

postgraduate_application_form_new_30102012