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Revised 2012

CHECKLIST
Please tick (  ) in the appropriate boxes to indicate items that have been attached. i. Processing fee of USD 25 or RM 75 (Remitted to IIUM Student Account)

ii. Four (4) copies of passport size photos
iii. Certified copies of Degree Certificate(s) - Original Version AND English Version (Bachelor Degree - compulsory (for PhD and Master's application) AND Master Degree (for PhD's application))

iv. Certified copies of Transcripts - Original Version AND English Version

v. Certified copy of TOEFL/IELTS (Compulsory to all application for English language programme)

vi. Two (2) certified copies of passport valid at least two (2) years - for student's visa preparation

vii. Reports from two (2) academic referees

viii. Preliminary Research Proposal. Applicable to:

PROGRAMME a. PhD b. Master

MODE OF PROGRAMME All modes Research Only

ix. Financial Statement

x. Any other relevant documents/professional qualifications

Signature

Date

IMPORTANT NOTICE: The application form will not be processed if: a. It is not accompanied with processing fees

b. Incomplete documents as per stated in the checklist

PG
Please tick () where applicable A. SEMESTER INTAKE:

POSTGRADUATE APPLICATION FORM

Passport Size Photo 5.5x4.0cm 4 copies
(1 photo- paste here)

SEPTEMBER INTAKE: SEMESTER I , SESSION (20___/20___) FEBRUARY INTAKE: SEMESTER II, SESSION (20___/20___)

JUNE INTAKE: SEMESTER III, SESSION (20___/20___)

B.

TYPE OF PROGRAMME:
PhD MASTER POSTGRADUATE DIPLOMA

C.

STATUS OF ADMISSION:
Full-Time Part-Time (Malaysian Only)

D.

TYPE OF APPLICATION:
IIUM Alumnus (Please indicate your previous Matrics No:_________________________) Agent Others Exhibition

E.

CODE OF PROGRAMME (Please check in the attachment):

First choice: Interested Field of Specialization:

Programme Structure:

Coursework

Coursework and Research

Research only

Professional Training and Research

Second choice: Interested Field of Specialization:

Programme Structure:

Coursework

Coursework and Research

Research only

Professional Training and Research

For CPS Office Use Only: Date Received Reference Number Remarks

IMPORTANT NOTICE: Incomplete form will not be processed

IIUM PG Application Form Page 2/5

F.

PERSONAL DETAILS

Name as stated in the I.C/Passport (CAPITAL LETTERS):

Citizenship(s):

No. of Dependent:

Date of Birth: (dd/mm/yy)

Gender:

Marital Status:

Ethnic Origin: (Malaysian Only)

Male

Female

Single

Married

Widow/Widower
Place of Issue:

Identity Card/Passport No. :

Date Passport Issued: (dd/mm/yy)

Passport Expiry Date: (dd/mm/yy)

Country/State of Origin:

Country of Residence:

Religion:

Denomination/Madzhab:

Mailing Address:

City/State: Postcode/ZIP Code: Telephone No: Country: Valid Email Address: (Compulsory)

Permanent Address: (If different from the above)

City/State: Postcode/ZIP Code: Telephone No: Country: Fax No: (If applicable)

IMPORTANT NOTICE: Incomplete form will not be processed

IIUM PG Application Form Page 3/5

Disability: (Please indicate any disability which may require the University to make special arrangement)

How did you obtain information on the IIUM?:

Friends

Advertisement

Internet Others

Exhibition / Promotion G. FAMILY DETAILS

Name of Father/Guardian/Spouse: Identity Card/Passport No.: Occupation: Address: No of Dependants: Telephone No.: Citizenship: Fax. No.:

Monthly Income (USD/RM)

Email Address:

H.

ACADEMIC BACKGROUND* i. Tertiary Education Master’s Degree Bachelor’s Degree Advanced Diploma Postgraduate Diploma

Name of Programme

Major Division / Class / CGPA / % From: Period of Study To Year Graduated Name of University / Institution : To : To : To : From: From: From:

Medium of Instruction
*Please enclose certified copies of all certificates, degrees and transcripts otherwise your...
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