APPLICATION FOR POSTGRADUATE PROGRAMMES
  
 
OPEN UNIVERSITI MALAYSIA
  
 
Date: 20:01 PM 20 May 2013
  
 
 
 
 
     
  A. PLEASE SELECT THE GRADUATE PROGRAMME APPLIED FOR  
   
* First
Second
Third
 
     
     
  B. PERSONAL PARTICULARS  
   
 
Salutation (e.g. Tan Sri/
    Datuk/Dato'/Datin/Mr/Mrs/Miss)
* Full Name
* Home/Postal Address
 
* Postcode *City
* State
* Country
 
     
 
Phone Number (House) Enter only numbers Phone Number (Office) Enter only numbers
* Handphone Enter only numbers Fax Enter only numbers
* Email
 
     
 
* NRIC/Passport Number Enter only alphabets/numbers Expiry Date / /
      (dd/mm/yyyy)
* Date of Birth
Nationality
* Gender Male Female
* Ethnicity Religion
Marital Status
 
   
   
  PERMANENT ADDRESS
 
* Address
 
* Postcode *City
* State
* Country
 
   
   
  IN CASE OF EMERGENCY, CONTACT:  
 
* Name
* Home/Postal Address
 
* Postcode *City
* State
* Country
*Tel. Home Enter only numbers
Tel. Office Enter only numbers
Handphone Enter only numbers
 
   
   
  * EDUCATION BACKGROUND  
     
  STPM / STP / HSC / A-Level  
 
Achieved
Year (From - To
Stream
School/College/University
Name of Institution
Grade
Number Subject Grade
1
2
3
4
5
 
     
     
 
Name of University/College
Diploma or Degree Awarded
Class Degree
CGPA
Year Graduated
Specialization
 
     
   
  * EMPLOYMENT BACKGROUND  
     
 
Job Titles
Organisation/Company
From        To
 
     
     
  * FINANCIAL SUPPORT  
  How do you plan to support your graduate studies ?
Personal    Scholarship    EPF
 
     
     
     
  PROFICIENCY IN THE ENGLISH LANGUAGE  
  Please tick the appropriate box.  
 
 
Excellent
Very Good
Good
Satisfactory
Weak
Written Communication
Verbal Communication
 
     
     
  Foreign Students are requested to submit their IELTS or TOEFL scores:  
 
   
Name of Test
Year Taken
Score
   
 
     
  * Please explain why you apply for the above graduate programme ? How can this programme assist you in your career development?  
   
  characters left
  
     
     
  E. ACKNOWLEDGEMENT  
     
 

I hereby certify that the information provided in this application form is correct to the best of my knowledge.
 
 
 
Name
Date 20:01 PM 20 May 2013