New Registration Form

Personal Particular

Full Name (as per NRIC)

Phone Number

Gender

NRIC/Passport Number (without -)

Nationality

Passport Country

Passport Expiry Date

Religion

Date of Birth

Marital Status

Programme Applied For

Full Time

Part Time

Weekdays

Weekends

Home Address

Current Address

How do you get information about NMUC?

Supervisor Name

Co-Supervisor 1 Name

Co-Supervisor 1 Institute

Co-Supervisor 2 Name

Co-Supervisor 2 Institute

Do you use Student Visa at any Malaysian Universities/Colleges?

Yes

Academic Background

Year	Degree Awarded	Institute / University	CGPA	Class	Major	Remarks

Working Experience

Year	Company	Designation	Years In Services	Remarks

English Proficiency

TOEFL	Score :		Date:		Reference Num. :
IELTS	Score :		Date:		Reference Num. :

Research Interest

Study Mode By:

Default

Research

Coursework

Proposed Topic

Research Grant (if any)

Research Area

Remarks

Financial Support

Do you receive any financial support from any organisation?

Yes

Name of Sponsor

Sponsor Status

Address of Sponsor

Referees

NOTE:

1. If applicable, upon your application submission, your referee will be notified via email to fill in Referee Report Form online.
2. If your referee does not have a valid email address or does not receive the email, please download the form here, print for your referee to fill in, and submit to us by mail after submission.

Name

Position

Organization

Address

Phone

Fax

Attachment

1 photo Passport Size (*JPEG ONLY) (JPEG)

Research Proposal (PDF)

1 sets of Curriculum Vitae (PDF)

Copy of IC (PDF)

Copy of Scroll Bachelor (PDF)

Copy of academic transcript Bachelor (PDF)

SPM/SPM(V) (PDF)

Copy of academic transcript Master (PDF)

Copy of Scroll Master (PDF)

I declare that I have checked all the information provided and cannot edit it after submitting the application.