Application For Admission to Postgraduate Programme

1. Please state the course you which you are applying for a) Research Degree Mphil Phd School

Reference No.

Please make sure that all the required fields are completed and all supporting documents are attached and sent to the address given on the last page of the form.

b) Taught Degree (eg Masters/Diploma) Full or Part-Time Study (Please tick one) Full -Time Proposed Date of Admission 2. Personal Details Title (Mr/Miss/Mrs/Ms) Forename (s) (as per NRIC/Passport) Surname/Family Name (as per NRIC/Passport) Date of Birth (Day/Month/Year) Gender For Malaysian Only Nationality Country of Permanent Residence Correspondence Address (Please note this is the address to which the University will send all correspondence) Male Race Female Passport/NRIC No. Marital Status Religion Single Married Part - Time

Town Email Address Telephone No (Daytime/Work)

State

Postcode Fax No. (Evening/Home) (Mobile)

Permanent Home Address (if different from address above)

Town

State

Postcode

Email Address Telephone No (Daytime/Work) (Evening/Home)

Fax No. (Mobile)

3. Academic History (Higher education institutions attended and qualification obtained or entered for (you must supply full dates) Please enclose a copy of transcript of your marks) Undergraduate Qualifications

Date From-To

Full or Part Time

Institution Name and Location

Degree/Major Obtained

Class/GPA/Final Average

Other information Relevant to your Academic History:

4. English Language Qualifications (Please enclose a copy of your English Language qualifications and specify which test you have taken with the results obtained and the date you took the test, or will be taking the test) Type of Test Score Date Obtained

Others (please specify)

5. Referees (Please name here two people who have completed your enclosed reference forms)

First referee Name Position Organisation Address

Second referee Name Position Organisation Address

Telephone No Fax No

Telephone No Fax No

6. Personal Statement Supporting Your Application (applicants for taught degrees only) Outline of Research Interest (applicants for research degrees only)

7. Career History (please give details of employment and/or professional experience (current first). Continue on a separate sheet if necessary)

Start and End Dates

Nature of Work and Position Held

Name and Address of Employer

8. Others

Do you have disability?

Yes

No

If Yes, please provide further details

Do you have any criminal conviction? If Yes, please provide further details

Yes

No

Where did you learn about The University of Nottingham Malaysia Campus and its programmes? (Please tick one box only) Advertisement (Please state newspaper/journal) Radio Careers Office College/Institution Exhibition/Careers Fair School Agent Personal Recommendation World Wide Web University Brochure British Council

Please check that your application is complete and that you have enclosed all the relevant documents Transcript of previous studies Two references in a signed and sealed envelope Copy of NRIC/Passport English Language qualification certificate

9. Declaration I certify that the information provided above is correct Signature Date

When completed please return to : The Admissions Office (Malaysian Applicants) or The International Admissions Office (International Applicants) The University of Nottingham Malaysia Campus Jalan Broga 43500 Semenyih Selangor Darul Ehsan Malaysia Tel: +6(03) 8924 8000 Fax: +6(03) 8924 8002 (Malaysian Applicants) / +6(03) 8924 8005 (International Applicants) Email: admissions@nottingham.edu.my (Malaysian Applicants) int-admissions@nottingham.edu.my (International Applicants) Website: http://www.nottingham.edu.my The University collects information about its students for various academic, administrative, health and safety reasons. The information is processed in accordance with the 'Malaysian Personal Data Protection (PDP) Act 2010, and is disclosed to third parties only with the individual's consent or to meet statutory obligation. The information provided on this application form will be stored electronically and used for administrative purposes by the university.