STUDENT APPLICATION FORM FOR UNDERGRADUATE PROGRAMME
FOREIGN STUDENT (NON MALAYSIAN CITIZEN)
Affix Passport-sized Photo

HOW TO COMPLETE THIS APPLICATION FORM

1 Please use black or blue ink pen only and write clearly using CAPITAL letters only.
All section must be completed. Please indicate as NA for section that not applicable.

2 Enclose one set of supporting documents that have been certified by recognised authorities, e.g. original issuing body. Supporting documents will NOT be returned. This application form is remain the property of UTP.
Note: Without supporting document(s), this application will be considered as incomplete and will not be processed

A PERSONAL INFORMATION NAME
DATE OF BIRTH - DD/MM/YYYY / / AGE PLACE OF BIRTH

GENDER-Please mark "X"
D MALE D FEMALE

MARITAL STATUS-Please mark "X"
D SINGLE D MARRIED D DIVORCED D OTHER

PASSPORT/ID NO

NATIONALITY

HOME PHONE- Country Code/Area Code/Number

CONTACTS
Please place each dot ',' and the @ symbol in its individual box

EMAIL
STREET NO STREET NAME

HOME ADDRESS
CITY STATE/PROVINCE

POSTAL CODE

COUNTRY

B FAMILY INFORMATION
FIRST NAME - Parent or Guardian

NAME
RELATIONSHIP NATIONALITY

HOME PHONE- Country Code/Area Code/Number

CONTACTS
Please place each dot ',' and the @ symbol in its own box

EMAIL

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C PROGRAMME PREFERENCE - PLEASE REFER TO SECTION J
1 2 3

PROGRAMME D ACADEMIC QUALIFICATIONS INFORMATION
EDUCATIONAL HISTORY
NO NAME OF SCHOOL/COLLEGE/UNIVERSITY

BEGIN - MMYY END - MMYY

DEGREE/DIPLOMA/CERTIFICATE

1 2 3 4 5 6 E QUALIFICATION DETAILS - Please list down your recent/highest qualification
NO DEGREE/DIPLOMA/CERTIFICATE SUBJECT OR UNIT GRADE/MARK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
PLEASE WRITE ON SEPARATE PAPER(FOLLOWING THE ABOVE FORMAT) IF SPACE PROVIDED IS NOT ADEQUATE

F HEALTH INFORMATION Do you EVER diagnose of having any critical disease ?
D NO D YES, if YES please specify

Are you physically disabled?
D NO D YES, if YES please specify

G DECLARATION I confirm that the information provided on the Applications Form are complete and true to the best of my knowledge and belief. I understand that providing incomplete, incorrect, of false information may result in the denial of my admission and subject me to the requirements and/or disciplinary measures as provided under the University ‘s rules and regulations and I shall have no claim against Universiti Teknologi PETRONAS in relation thereto.

Date:_______________________

Signature: ________________________________________

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H APPLICATION CHECKLIST
Have you:

Completed the application form and signed it Attached copy(ies) of passport and/or identity card Attached most recent passport sized photos Attached all relevant secondary and/or tertiary academic transcript and certificates Attached all relevant sports and curriculum certificates (if any)
Please forward completed application to:

Admission and Registration Unit, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 31750 Tronoh, Perak, Malaysia (Attention: Undergraduate for International Student Admission)

I

ENTRY REQUIREMENTS

Applicants must successfully completed High School Certificate/Diploma with average score of 80 percent or B or CGPA of 3.00/4.00.
Prerequisites for Engineering Programme

Obtained 80 percent or B or Grade of 3.00/4.00 for Mathematics, Physics, Chemistry, AND any two (2) other relevant subjects such as Additional Mathematics, Geography, Accounting, History, Economics, Commerce, General Science and etc.
Prerequisites for Technology Programme

Obtained 80 percent or B or Grade of 3.00/4.00 for Mathematics, AND any four (4) other relevant subjects such as Additional Mathematics, Physics, Chemistry, Geography, Accounting, History, Economics, Commerce, General Science and etc.
English Language Proficiency

a) IELTS – score of 6.0; OR b) TOEFL – paper-based score of 550 or equivalent.

Note:
The University reserves the right to alter or discontinue its programs as required. The entry requirement stated on this application form should be used as a general guideline for admission only, the University may change these requirements at any time.

J PROGRAMME CODE
PLEASE USE THE FOLLOWING PROGRAMME CODE FOR SECTION C ENGINEERING
CV00 - CIVIL ENGINEERING ME00 - MECHANICAL ENGINEERING CH00 - CHEMICAL ENGINEERING EE00 - ELECTRICAL AND ELECTRONICS ENGINEERING PE00 - PETROLEUM ENGINEERING GS00 - PETROLEUM GEOSCIENCE CO03 - INFORMATION AND COMMUNICATION TECHNOLOGY CO04 - BUSINESS INFORMATION SYSTEM

TECHNOLOGY

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