Universiti Tunku Abdul Rahman Form Title: APPLICATION FORM

Form Number: FM-DACE-002 Rev No. : 1 Effective Date: 01/06/2002 Page No: 1 of 7

Ref. No (For Office Use)

UNIVERSITI TUNKU ABDUL RAHMAN

Wholly owned by UTAR Education Foundation (Co. No. 578227 M)

Application Form January 2012 Intake (Bachelor Honours Degree Programmes)

Section A: To be completed by applicant I. PERSONAL INFORMATION 1. Name (as in NRIC): ___________________________________________________________ 2. NRIC No: (Day/Month/Year)

3. Nationality: __________________ 5. Gender: Male Female

4. Date of Birth: _____________________________

6. Address: ____________________________________________________________________ ____________________________________________________________________________ Postcode: ___________________________ 7. Contact No: (H)______________________ State: _______________________________ (H/P): _______________________________

8. E-Mail: _____________________________________________________________________ 9. Race: 10. Religion: Malay Islam Chinese Buddhism Indian Hinduism Others _________________________
(Please specify)

Christianity

Others _________
(Please specify)

11. Do you suffer from any physical disability or illness? If so, please specify the nature of these conditions. Otherwise, state None. ____________________________________________________________________________ II. COURSE APPLICATION DETAILS You can select up to a maximum of 5 choices. Please indicate your choice of course(s) in order of preference by writing down (1, 2, 3, 4, 5). No Courses Offered
Institute of Chinese Studies (Perak Campus) 1. Bachelor of Arts (Hons) Chinese Studies

Order of Preference

Universiti Tunku Abdul Rahman Form Title: APPLICATION FORM

Form Number: FM-DACE-002 Rev No. : 1 Effective Date: 01/06/2002 Page No: 2 of 7

No

Courses Offered
Faculty of Arts and Social Science (Perak Campus)

Course Preference

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36.

Bachelor of Communication (Hons) Journalism Bachelor of Communication (Hons) Public Relations Bachelor of Communication (Hons) Advertising Bachelor of Social Science (Hons) Psychology Bachelor of Arts (Hons) English Language Bachelor of Arts (Hons) English Education Faculty of Business and Finance (Perak Campus) Bachelor of Commerce (Hons) Accounting Bachelor of Business Administration (Hons) Bachelor of Business Administration (Hons) Banking and Finance Bachelor of Business Administration (Hons) Entrepreneurship Bachelor of Marketing (Hons) Bachelor of Economics (Hons) Financial Economics Bachelor of Finance (Hons) Faculty of Science (Perak Campus) Bachelor of Science (Hons) Biotechnology Bachelor of Science (Hons) Chemistry Bachelor of Science (Hons) Biochemistry Bachelor of Science (Hons) Biomedical Science Bachelor of Science (Hons) Statistical Computing and Operations Research Bachelor of Science (Hons) Microbiology Bachelor of Science (Hons) Logistics and International Shipping Bachelor of Science (Hons) Agricultural Science Faculty of Engineering and Green Technology (Perak Campus) Bachelor of Engineering (Hons) Electronic Engineering Bachelor of Engineering (Hons) Environmental Engineering Bachelor of Engineering (Hons) Petrochemical Engineering Bachelor of Engineering (Hons) Industrial Engineering Bachelor of Science (Hons) Construction Management Faculty of Information and Communication Technology (Perak Campus) Bachelor of Computer Science (Hons) Bachelor of Information Systems (Hons) Information Systems Engineering Bachelor of Information Systems (Hons) Business Information Systems Bachelor of Information Technology (Hons) Computer Engineering Bachelor of Information Technology (Hons) Communications and Networking Faculty of Creative Industries (Petaling Jaya Campus) Bachelor of Communication (Hons) Broadcasting Bachelor of Corporate Communication (Hons) Bachelor of Media and Creative Studies (Hons) Bachelor of Arts (Hons) Graphic Design and Multimedia

Universiti Tunku Abdul Rahman Form Title: APPLICATION FORM

Form Number: FM-DACE-002 Rev No. : 1 Effective Date: 01/06/2002 Page No: 3 of 7

No

Courses Offered
Faculty of Creative Industries (Petaling Jaya Campus)

Order of Preference

37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62.

Bachelor of Arts (Hons) Game Design Bachelor of Arts (Hons) Journalism in Chinese Media Bachelor of Arts (Hons) Early Childhood Studies Faculty of Accountancy and Management (Sg.Long Campus) Bachelor of Economics (Hons) Global Economics Bachelor of International Business (Hons) Bachelor of Accounting (Hons) Bachelor of Building and Property Management (Hons) Faculty of Engineering and Science (Kuala Lumpur Campus) Bachelor of Engineering (Hons) Electrical and Electronic Engineering Bachelor of Engineering (Hons) Mechanical Engineering Bachelor of Engineering (Hons) Materials and Manufacturing Engineering Bachelor of Engineering (Hons) Civil Engineering Bachelor of Engineering (Hons) Electronic and Communications Engineering Bachelor of Engineering (Hons) Biomedical Engineering Bachelor of Engineering (Hons) Chemical Engineering Bachelor of Engineering (Hons) Mechatronics Engineering Bachelor of Engineering (Hons) Electronics (Computer Networking) Bachelor of Science (Hons) Actuarial Science Bachelor of Science (Hons) Applied Mathematics with Computing Bachelor of Science (Hons) Financial Mathematics Bachelor of Science (Hons) Physics Bachelor of Science (Hons) Architecture Bachelor of Science (Hons) Quantity Surveying Bachelor of Science (Hons) Software Engineering Faculty of Medicine and Health Sciences (Sg.Long Campus) Bachelor of Chinese Medicine (Hons) Bachelor of Nursing (Hons) Bachelor of Physiotherapy (Hons)

III. ACADEMIC QUALIFICATION

* Delete whichever is not applicable

1. Last School/Institution Attended

a) Name: ____________________________________________________________________________ b) Address: __________________________________________________________________________

Universiti Tunku Abdul Rahman Form Title: APPLICATION FORM

Form Number: FM-DACE-002 Rev No. : 1 Effective Date: 01/06/2002 Page No: 4 of 7

2. Qualification a) No.
1. 2. 3. 4. 5. 6.

* SPM/Others: ____________________________________________________________
(Please specify)

Subjects

Grade

No.
7. 8. 9. 10. 11. 12.

Subjects

Grade

b) No.
1. 2. 3. 4. 5.

* STPM/A-Levels/SAM/CPU/UEC/Others: _____________________________________
(Please specify)

Subjects

Grade

No.
6. 7. 8. 9. 10.

Subjects

Grade

c)

Other Qualification: : : : :

Name of Institution Level of Study Name of Award CGPA/Grade

3. English Language Proficiency: (Please fill in your grade)

IELTS TOEFL ENGLISH 1119/O-LEVEL MUET

4. July Paper(s): (Please fill in your grade)

BAHASA MELAYU ENGLISH LANGUAGE MATHEMATICS

IV. CO CURRICULUM ACTIVITIES 1. Sports 2. Uniform 3. Clubs/Societies :______________________________________________________________ :______________________________________________________________ :______________________________________________________________

Universiti Tunku Abdul Rahman Form Title: APPLICATION FORM

Form Number: FM-DACE-002 Rev No. : 1 Effective Date: 01/06/2002 Page No: 5 of 7

V. PARTICULARS OF PARENT/GUARDIAN 1. Name of Parent/Guardian: ______________________________________________________ 2. Address of Parent/Guardian: _____________________________________________________ ______________________________________________________________________________ 3. Relationship: __________________________________________________________________ 4. Occupation: ___________________________________________________________________ 5. Contact No: (H) __________________________ (O) : ____________________________

VI. DECLARATION BY APPLICANT I declare that the information provided by me in connection with this application is true and correct. I understand that Universiti Tunku Abdul Rahman reserves the right to withdraw the offer of admission or ask me to leave the University at any time if such information is found to be false or incorrect.

__________________________ Name of Applicant Section B: For Office Use Date Received:

_____________________ Signature of Applicant Incomplete:

_____________ Date

Complete and Processed:

Processing fee of RM60.00 Certified true copy of SPM/STPM/A-

Levels/SAM/CPU/UEC results Certified true copy of School Leaving Certificate Birth Certificate/Identity Card Others _____________________________

Name of Staff-in-charge: Remarks:

Date:

Universiti Tunku Abdul Rahman Form Title: APPLICATION FORM

Form Number: FM-DACE-002 Rev No. : 1 Effective Date: 01/06/2002 Page No: 6 of 7

VII. APPLICATION INSTRUCTIONS Completed application form must be submitted together with the following documents: (All documents must be certified by School Principal/Justice of Peace/State Assemblyman/Member of Parliament) 1. Certified true copy of actual/forecast SPM/Other equivalent results; 2. Certified true copy of actual/forecast STPM/A-Levels/SAM/CPU/UEC/Other equivalent results; 3. Certified true copy of School Leaving Certificate; 4. Certified true copy of Birth Certificate; 5. Certified true copy of Identity Card; 6. Certified true copy of MUET result (compulsory for STPM holders); 7. A non-refundable processing fee of RM60.00 in money order/postal order/bankdraft made payable to Universiti Tunku Abdul Rahman. (Please note that personal cheque/cash is NOT
accepted);

8. Self-addressed envelope measuring 7 X 10 affixed with RM0.90 stamp; and 9. Self-addressed envelope measuring 3.5 X 6 affixed with RM0.60 stamp; If you are using other equivalent qualification(s), for example, Diploma or Advanced Diploma from a College/Institution/Polytechnic, you are also required to submit together with the application form: 1. 2. 3. 4. Certified true copy of Certificate of Awards; Official academic transcripts; Course structure and syllabi; All relevant information and materials related to your previous studies from SPM onwards.

Applications submitted without the above documents will be processed for normal admission without any consideration for credit transfer. Please send the application form to: Department of Admissions and Credit Evaluation Universiti Tunku Abdul Rahman PO Box 11384 50744 Kuala Lumpur OR Jalan Universiti, Bandar Barat 31900 Kampar Perak Darul Ridzuan

Please indicate UTAR JANUARY 2012 INTAKE on the top left corner of the envelope.

Acknowledgement Slip
(Please submit this slip together with the completed application form) * Name: ______________________________________________________________________ * Address: ____________________________________________________________________ __________________________________________ ___________________________________ 6

RE: APPLI Universiti Tunku Abdul Rahman Form Title: APPLICATION FORM
Form Number: FM-DACE-002 Rev No. : 1 Effective Date: 01/06/2002 Page No: 7 of 7

CATION FOR ADMISSION TO UNIVERSITI TUNKU ABDUL RAHMAN JANUARY

Acknowledgement Slip
(Please submit this slip together with the completed application form) * Name: ______________________________________________________________________ * Address: ____________________________________________________________________ _____________________________________________________________________________

RE: APPLICATION FOR ADMISSION TO UNIVERSITI TUNKU ABDUL RAHMAN JANUARY 2012 INTAKE
Your application for admission to Universiti Tunku Abdul Rahman has been received on _____________________________. Please be informed that :You have completed the application form and submitted all certified true copies of the results and documents as required. Kindly note the following: You have not completed fully the application form. Please call us at 03 7958 2628 / 05 4688 888 or e-mail us at admission@utar.edu.my for further clarification. You have not submitted application fee of RM60.00 made payable to Universiti Tunku Abdul Rahman in postal order/money order/ bank draft. You have not attached certified true copy of your actual/ forecast/ trial SPM/ SPMV/ STPM/ A-Level/ SAM/ CPU/ UEC/ MUET/ other examination results. You have not attached certified true copy of your Diploma certificate/ transcript/ syllabus/ course structure/ complete Diploma results (KTAR)/ others. You have not attached certified true copy of your IC/ birth certificate/ school leaving certificate/ others. Kindly send the outstanding documents to us by ___________________________. The University is not bound to process your application if you do not submit the documents as required before or by the stipulated date.

* To be completed by applicant

Department of Admissions and Credit Evaluation