附件三：博特拉大学交流生申请表.pdf

UPM/BA/SAIN/BR01 INTERNATIONAL DIVISION UNIVERSITI PUTRA MALAYSIA Please stick passport sized picture here 43400 UPM Serdang, Selangor Malaysia Tel: 86 10 51650127 Fax: 86 1064032524 E-mail : umsstudy@aliyun.com Website: upm.edu.my APPLICATION FOR STUDY IN UPM (INBOUND) A. NAME OF PROGRAMME : Exchange / Short Term / Internship / Visits B. APPLICANT / PARTICIPANT PERSONAL DETAILS (COMPULSARY) Name (Mr./Mrs./Miss) Date of Birth Age Place of Birth Race Gender Male Citizenship/ Nationality Passport Number E-mail address Marital Status Religion Female Married Mobile Number umsstudy@aliyun.com Next of kin Contact number Home address State & Country Postcode C. EDUCATION AT HOME UNIVERSITY (COMPULSARY) Current Home University (name & full address) Phone number Fax number E-mail address University web site Faculty which applicant will be attached to at home university Degree Programme Degree Level Current result (CGPA) Diploma Bachelor Masters PhD Current semester Expected year of graduation Academic awards obtained (please specify name of award, organiser & date received): 16/12/2011 Single UPM/BA/SAIN/BR01 D. OTHERS (CO-CURRICULUM ACTIVITIES / SPECIAL SKILLS) Co-curriculum activities : Special skills : E. STUDY IN UPM (COMPULSARY) Faculty / Institute applied in UPM Does this university have MoU with UPM? Type of exchange (For Student Exchange Programme only) Yes No Exchange Programme (1 or 2 semester) Short term Programme (less than 1 semester)  Mobility 1000 (2 weeks or more)  Short Mobility (7-13 days)  Industrial Training (with credit) Internship Programme (work/research attachment) Visits (less than 7 days) Others, please specify _______________________________________ Period of study (in UPM) Commencing _______________________ to __________________________ Please specify your research project (if relevant) Transfer of credits required (Please fill in the Academic Transcript Form) Yes No Proposed courses to be taken in UPM: ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ 16/12/2011 UPM/BA/SAIN/BR01 F. FINANCE (COMPULSARY) How would you intend to finance your programme? Self-sponsored Home Institution Sponsor Please specify details of sponsorships (Sponsoring Body/Institution/Association): ___________________________________________________________________________________ G. LANGUAGE Native Language Language proficiency English Proficient Moderate Weak Malay Proficient Moderate Weak Others (specify) Proficient Moderate Weak ______________________________________________ H. INTER-OFFICE COMMUNICATION (COMPULSARY) Please include the contact person from the home university (international affairs officer/student exchange coordinator) who is responsible for correspondence. Name (Mr. / Miss / Mrs.) Position Office/Department Correspondence address Phone number Fax number E-mail address I hereby declare that the information provided in this form is true. Signature : ____________________________________ Name : ____________________________________ Date: ________________________ NOTE: * Incomplete application form will not be processed ** Please submit copy of Academic Transcript, 4 current colored photographs (passport size) and a copy of your passport (front page only) 16/12/2011