OFFICE USE ONLY

PLEASE TICK √ WHERE APPLICABLE

Processing Fee
Qualified Sem ___
Not qualified
Not complete
EPT
UNIVERSITI KUALA LUMPUR Road shows
APPLICATION FORMS (BORANG PERMOHONAN) Remarks:

Instructions Arahan:
►Please fill all information required in CAPITAL LETTERS.
Sila tulis dengan HURUF BESAR
►For box with * sign, please fill out based in guidelines given.
Bagi kotak bertanda *, sila isi kod berdasarkan panduan mengisi borang
►Please tick √, where applicable.
Sila tanda √, di mana sepatutnya
SECTION 1: PROGRAMME PREFERENCE PROGRAM PILIHAN

First Pertama * Second Kedua * Third Ketiga *

Semester: Jan May* (Foundation programme only) July Year Tahun 2000
Mei * (untuk pengambilan program Persediaan sahaja) Julai

Do you accept if being offered into other programmes? Yes Ya No Tidak

Adakah anda setuju ditawarkan program lain

SECTION 2: PERSONAL DETAILS MAKLUMAT PERIBADI

Full Name
Nama Penuh

Correspondence Address Alamat Surat Menyurat

Postcode
Poskod

State/Country
Negeri

IC/Passport No. Nationality

Kad Pengenalan Warganegara

Contact No. Hand phone No.

No. Telefon Telefon Bimbit

Gender Male Lelaki Female Perempuan Race Kaum

Jantina (For Malaysian Only)

Religion Marital Status

Agama Taraf Perkahwinan

Age Date of Birth Email Address

Umur Tarikh Lahir Alamat Email

Medical Background Latar Belakang Kesihatan : Disability * Chronic Disease*

Kecacatan Anggota Penyakit Kronik

SECTION 3: PARENTS/GUARDIAN INFORMATION Maklumat Ibubapa/Penjaga

Full Name Nama Penuh Relationship Hubungan Address Alamat Contact No.
Telefon No

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SECTION 4: QUALIFICATION INFORMATION MAKLUMAT PENDIDIKAN

SPM/SPMV/O’LEVEL
Please fill out grade achieved for: SPM 1, 2, 3, 4, 5, 6, 7, 8, 9 and O’Level A, B, C, D, E, F, G
Sila isikan nilai gred : SPM 1, 2, 3, 4, 5, 6, 7, 8, 9, dan O’Level A, B, C, D, E, F, G

Year Tahun

Subjects Mata pelajaran Grade Gred Subjects Mata pelajaran Grade Gred

1. BAHASA MELAYU 5.

2. BAHASA INGGERIS 6.

3. 7.
MATEMATIK / MATHEMATICS

4. 8.

FOR MALAYSIAN APPLICANTS ONLY Kertas Julai SPM

BAHASA MELAYU BAHASA INGGERIS MATEMATIK

STPM/A’LEVEL
Please fill out grade achieved A, A-, B+,B, B-,C+, C, C-, D+,D-,D, E, F, R
Sila isikan nilai gred a, A-, B +, B, B-, C +, C, C-, D +, D-, D, E, F, R

Year Tahun

Subjects Matapelajaran Grade Gred Subjects Matapelajaran Grade Gred

1. 4.

2. 5.

3. 6.

OTHER QUALIFICATIONS KELAYAKAN LAIN

Highest Qualification
Keputusan Tertinggi

Major / Specialization
Bidang

Univ/Institute Univ/Institut

CGPA/Grade* . Have you completed your studies? Yes Ya No Tidak

CGPA/Gred Adakah anda sudah menamatkan pengajian?

Note(*):For applicants from IKM/ILP/IKBN/SKM, please fill out CGPA as 2.00 if your result is competent.
Pemohon dari IKM/ILP/SKM, hendaklah mengisi gred CGPA sebagai 2.00 jika keputusan anda Terampil.

SECTION 5 : ENGLISH PROFICIENCY (FOR INTERNATIONAL APPLICANTS ONLY)

TOEFL Score OR IELTS Score

SECTION 6: DECLARATION PENGAKUAN

I declare that the information given in this form is true & correct. I understand that my application can be rejected in the event that I have
submitted incorrect and incomplete information with false document.
Saya akui semua maklumat dan dokumen yang diberikan adalah benar dan lengkap. Saya memahami bahawa sekiranya ada di
antara maklumat ini didapati palsu atau tidak lengkap, permohonan saya boleh ditolak.

Applicant’s Signature: Date:

Tandatangan Pemohon: Tarikh:

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CHECKLIST FOR APPLICANT SENARAI SEMAK PEMOHON

The following document must be submitted together with application form.

Perkara berikut hendaklah dikemukakan bersama borang permohonan

FOR LOCAL & INTERNATIONAL APPLICANT

Untuk Pelajar Malaysia & Antarabangsa

□ Certified true copy of Salinan Sijil yang disahkan :

O SPM/SPMV/O’Level certificates and dan
O STPM/A’Level certificates or atau
O Certificate/Diploma certificates with transcript/results slip of every semester.
Sijil/Diploma berserta transkrip/slip keputusan peperiksaan setiap semester.

□ Certification Letter on Completion of Studies from previous institutions, if applicants still waiting for final result.
Salinan Surat Akuan Tamat Belajar dari Institutsi Pengajian terdahulu sekiranya masih menunggu keputusan akhir.

Note For International Applicants: If academic records in language other than English, it must be accompanied with approved translation.

For Local Applicant Untuk Pemohon Warganegara For International Applicant Untuk Pemohon Antarabangsa

□ A copy of NRIC and Birth Certificates

□ 3 photocopies of passport (A4 size), all pages including blank
Salinan Kad Pengenalan dan Surat Beranak pemohon
Pages.

□ A copy of Bank-in slip from CIMB Bank Berhad, payable to Universiti

□ 8 passport size colour photograph (3.5 cm X 5.0 cm) with light
Teknikal Mara. Sdn. Bhd, account no: 14081204891058 as prove of
blue background and name written on reverse.
payment for Processing fee (non refundable) with the amount
RM10.00.
□ A non refundable application processing fee of RM100.00 in
Salinan Slip Simpanan Wang Tunai dari CIMB Bank Berhad di atas
a from cash or bankdraft payable to Universiti Teknikal Mara
nama Univerisiti Teknikal Mara. Sdn. Bhd, nombor akaun
Sdn. Bhd account no. 14081204891058.
14081204891058 sebagai bukti bayaran yuran pemprosesan tidak
dikembalikan berjumlah RM 10.00.

Note: For applicants applying for MBBS Programme, the processing Note: Please submit your application :
fee is RM100.00. ■ 2 months before beginning of the next semester if you
Yuran Pemprosesan untuk Program MBBS, berjumlah RM100.00 are abroad OR
■ 1 month before beginning of next semester if you are
in Malaysia.
□ Application for MBBS programme, Please attach:
Pemohon program MBBS perlu melampirkan:
o Parent’s/Guardian’s EA form - Annual Income Statement
Borang EA, Penyata Pendapatan Tahunan ibubapa.
o Essay on ‘What Motivates You To Become a
Doctor”.
Karangan bertajuk ‘Motivasi Anda Untuk Menjadi Seorang Doktor.

PLEASE SEND APPLICATION TO SILA HANTAR BORANG PERMOHONAN KE:

Academic Affairs Division, Level 3 Universiti Kuala Lumpur, 1016, Jalan Sultan Ismail, 50250 Kuala Lumpur, Malaysia.
Bahagian Hal Ehwal Akademik, Aras 3 Universiti Kuala Lumpur, 1016 Jalan Sultan Ismail, 50250 Kuala Lumpur, Malaysia.

PLEASE CHECK YOUR APPLICATION STATUS AT http://online.unikl.edu.my within 1 month from date you send in application.
SILA SEMAK STATUS PERMOHONAN ANDA DI http://online.unikl.edu.my 1 bulan dari tarikh penghantaran borang permohonan.

3
GUIDELINES PANDUAN MANGISI BORANG

MEDICAL BACKGROUND LATAR BELAKANG KESIHATAN

Physical Disability Kecacatan Anggota Chronic Disease Penyakit Kronik

CODE DESCRIPTION CODE DESCRIPTION

Kod Keterangan Kod Keterangan
00 No Disability Tiada Kecacatan 00 No Chronic Disease Tiada Penyakit Kronik
01 Blind Buta 01 Bladder Stone or Gall Stone Batu Karang dalam pundi kencing, Hempedu serta kolestisis
02 Deaf one ear/both Pekak sebelah telinga/kedua-dua 02 High Blood Tekanan Darah Tinggi
03 Dumb Bisu 03 Diabetes (Kencing manis)
04 Disability – Leg Kecacatan – Kaki Disease regarding blood/brain vessel Penyakit berkaitan saluran darah atau pembuluh
04
otak
05 Disability – Hand Kecacatan – Tangan 05 Cataract Katarak dan ptegrium
06 Long/Short Sighted Rabun Jauh/Dekat 06 Tumor Semua Jenis Ketumbuhan
07 Colour Blind Buta Warna 07 Cancer Semua jenis Barah
08 Others Lain-lain 08 Hernia Buasir, Fistulate, Hydrocale
09 Knee/Backbone Problem kerosakan berkaitan Tulang belakang/Lutut
10 Endometriosis
11 Epilepsy Epilepsi
12 Gastric Gastrik
13 Ulcer Ulser
14 Eritematocus
15 Prostate Glen Disease Penyakit Kelenjar Prostat
16 Organ Disfunctional e.g Kidney, Heart Kegagalan Organ seperti Ginjal, Hati
17 Mental Illness Penyakit Mental
18 HIV Aids
19 Others Lain-lain

4
PROGRAMME PREFERENCE PILIHAN PROGRAM

OFFER SEM OFFER SEM

INSTITUTE PROGRAMME CODE INSTITUTE PROGRAMME Code
JAN JUL JAN JUL

Bachelor of Engineering Technology (Hons) in Networking Systems A11 √ √ Bachelor of Engineering Technology (Hons) in Air Conditioning & Industrial Refrigeration F11 √ √
Bachelor of Computer Engineering (Hons) A12 √ Bachelor of Engineering Technology (Hons) in Industrial Automation & Robotics F12 √ √
Bachelor of Information Technology (Hons) in Software Engineering A13 √ √ Bachelor of Engineering Technology (Hons) in Mechatronics F13 √ √
Bachelor of Information Technology (Hons) in Computer E Commerce A14 √ Bachelor of Engineering Technology (Hons) in Machine Tools Manufacturing F14 √ √
Bachelor of Information Technology (Hons) in Computer Systems Security A15 √ √ Bachelor of Engineering Technology (Hons) in Welding and Quality Inspection F15 √
Bachelor of Multimedia Technology (Hons) in Interactive Multimedia Design A16 √ √ Diploma of Engineering Technology in Automated System Maintenance F01 √ √
Bachelor of Multimedia Technology (Hons) in Computer Animation Design A17 √ UniKL MFI Diploma of Engineering Technology in Electrical Equipment & Installation F02 √ √
MIIT
Bachelor of Business Technology (Hons) in Computer Entrepreneurial
A18 √ √ Diploma of Engineering Technology in Machine Building & Maintenance F03 √ √
Management
Diploma in Information Technology A01 √ Diploma of Engineering Technology in Air Conditioning & Refrigeration F04 √ √
Diploma in Multimedia A02 √ √ Diploma of Engineering Technology in Metal Fabrication F05 √ √
Diploma of Engineering Technology in Computer & Networking A03 √ √ Diploma of Engineering Technology in Welding F06 √ √
Diploma in Animation A04 √ Diploma of Engineering Technology in Automotive Maintenance F08 √ √
Diploma of Engineering Technology in Computing A05 √ √ Bachelor of Aircraft Engineering Technology (Hons) - Mechanical M11 √ √
Bachelor of Engineering Technology (Hons) in Tool and Die U13 √ √ Diploma in Aircraft Maintenance Technology (Avionics) M01 √
Bachelor of Engineering Technology (Hons) in Product Design U14 √ √ Diploma in Aircraft Maintenance Technology (Composite) M02 √
Bachelor of Engineering Technology (Hons) in Business Management U15 √ √ UniKL MIAT Diploma in aircraft Maintenance Technology (Manufacturing) M03 √
IPROM
Bachelor of Engineering technology (Hons) in Supply Chain Management U16 √ √ Diploma of Engineering Technology in Avionics Maintenance M04 √ √
Bachelor of Engineering Technology (Hons) in Industrial Design U17 √ √ Diploma of Engineering Technology in Helicopter Maintenance M05 √ √
Bachelor of Engineering Technogy (Hons) in Manufacturing System U18 √ √ Diploma of Engineering Technology in Aeroplane Maintenance M06 √ √
Bachelor of Engineering Technology (Hons) in Electrical B11 √ √ Bachelor of Engineering Technology (Hons) in Mecahnical (Automotive) S11 √
Bachelor of Engineering Technology (Hons) in Electronics B12 √ √ Bachelor of Engineering Technology (Hons) in Mechatronics (Automotive) S12 √
Bachelor of Engineering Technology (Hons) in Data Communication B13 √ √ Bachelor of Engineering Technology (Hons) in Manufacturing (Automotive) S13 √
UniKL BMI Bachelor of Engineering Technology (Hons) in Mobile Communication B14 √ √ Diploma of Engineering Technology in Mechanical Design & Development S01 √ √
UniKL MSI
Diploma of Engineering Technology in Electrical & Electronics B01 √ √ Diploma of Engineering Technology in Mould Manufacturing S02 √
Diploma of Engineering Technology in Medical Electronics B03 √ √ Diploma of Engineering Technology in Production Engineering S03 √
Diploma of Engineering Technology in Telecommunication B04 √ √ Diploma of Engineering Technology in Automated Regulation & Control S04 √
Bachelor in Biosystem Engineering Technology (Hons) C11 √ Diploma of Engineering Technology in Electromechanical Installation & Maintenance S05 √ √
Bachelor of Chemical Engineering Technology (Hons) in Process C13 √ Bachelor of Engineering Technology (Hons) in Naval Architecture & Shipbuilding R11 √ √
Bachelor of Chemical Engineering Technology (Hons) in Environment C14 √ Bachelor of Engineering Technology (Hons) in Naval Architecture & Subsea* R12 √
Bachelor of Chemical Engineering Technology (Hons) in Polymer C16 √ UniKL Diploma of Engineering Technology in Ship Design R01 √ √
Bachelor of Chemical Engineering Technology (Hons) in Bioprocess C17 √ MIMET Diploma of Engineering Technology in Ship Construction & Maintenance R02 √ √
UniKL
MICET Bachelor of Chemical Engineering Technology (Hons) in Food C18 √ Diploma of Engineering Technology in Marine Engineering R03 √ √
Diploma in Chemical Engineering Technology (Bioprocess) C01 √ Diploma of Engineering Technology in Marine Electrical & Electronic R04 √ √
Diploma in Chemical Engineering Technology (Process) C02 √ Bachelor of Medicine & Bachelor of Surgery (MBBS) D11 √
Diploma in Chemical Engineering Technology (Environment) C03 √ UniKL Diploma in Pharmacy D01 √ √
Diploma in Chemical Engineering Technology (Food) C04 √ RCMP Diploma in Radiography D02 √ √
Diploma in Chemical Engineering Technology (Polymer) C05 √ Diploma in Nursing D03 √ √
COPS Foundation in Engineering Technology E01 May Intake Bachelor of Medical Science Technology (Hons) in Clinical Laboratory Science T11 √ √
√ √ √
Bachelor of Engineering Technology (Hons) in Quality Engineering Q11 Bachelor of Medical Science Technology (Hons) in Environmental Healthcare T12
UniKL √ UniKL √ √
Bachelor of Industrial Logistics (Hons) * Q01 MESTECH Diploma of Medical Science Technology in Biomedical Lab Science T01
PASIR
GUDANG Diploma of Engineering Technology in Quality Engineering Q12 √ √ Diploma of Medical Technology in Environmental Health Science T02 √ √
√ √
Diploma in Industrial Logistics * Q02

Note: i. * UniKL will offer programme upon getting approval from Malaysia National Accreditation Board.
* Program akan hanya ditawarkan selepas mendapat kelulusan pengendalian daripada Lembaga Akreditasi Negara.

ii. Programme offered by semester is subject to change

Program ditawarkan berdasarkan semester adalah tertakluk kepada perubahan.
Updated: 220808