汝来大学申请表.pdf

STUDENT APPLICATION FORM Passport Size Photo Intake: Jan Feb Mar Apr May Jun Jul Aug Sep Oct 20 STUDENT ID PROGRAMME APPLIED A. PERSONAL DATA Please complete all the sections using BLOCK LETTERS. STUDENT’S DATA Surname / Family Name Given Name / Other Name *Marital Status Single Divorced Married Widowed *Gender Male Female Name as Stated on IC / Passport Nationality *Place of Birth Date of Birth D D Passport No. (For International Students Only) M M Y Y Y Y NRIC No. (For Malaysian Students Only) Expiry Date D D M M Y Y Y Y Correspondence Address State Country Postcode Tel. No. with Country Code Mobile Phone No. * Religion Muslim Christian Hindu *Ethnic Origin (For Malaysian Only) Malay Pribumi Chinese Buddhist Other Indian Other Email Address * Information required by the Ministry of Higher Education Malaysia B. SIBLINGS The university would appreciate if you could list the name of your sibling(s) enrolled in Nilai University. NAME STUDENT ID PROGRAMME C. PARENT’S / GUARDIAN’S / SPONSOR’S DATA Name as Stated on IC / Passport Title: Mr / Mrs / Ms / Madam Relationship to Student: Passport No. (Non-Malaysian) NRIC No. (Malaysian ) Permanent Address State Country Tel. No. Mobile Phone No. Postcode Email Address D. EDUCATION BACKGROUND SPM / O-Levels UEC Foundation STPM / A-Levels Degree Certificate SAM / CPU Diploma Name of School / Institution State / Country Other (Please Specify) E. ENGLISH PROFICIENCY SPM / O-Levels English Grade: TOEFL Score: IELTS Band: Intensive English Programme MUET Band: Others: F. IMMIGRATION PASS INFORMATION ( For International Students Only) 1. Currently holding any Malaysian Immigration Pass / Visa? 2. If yes, type of Immigration Pass / Visa: Expiry Date : D D M M Yes No Student Dependent Diplomatic MM2HP (Malaysia My Second Home Programme) Y Y Y Social Y Applicable to students / former students from other institutions in Malaysia only: Institution : Year / Duration : Programme : G. ACCOMMODATION Required* Not Required * If required, please complete the Accommodation Application Form with a Room Booking Fee of RM150.00. H. DISABILITY / CRITICAL ILLNESS Please indicate form of disability / critical illness, if any. This is for support purposes only and will not affect the outcome of your application. No, I do not have any form of disability / critical illness. Yes. Please describe : I. REFUND POLICIES AND PROCEDURES A. APPLICABLE TO ALL STUDENTS I hereby acknowledge, understand and agree that: 1. The Application and Registration Fees paid are strictly, NON REFUNDABLE under any circumstances. 2. Once the initial fees are fully utilised, fees will be charged based on the Approved Course Enrolment each subsequent semester. 3. When a request for refund is desired, the request has to be explicitly expressed in writing and in accordance to the guidelines and deadlines stipulated in the following clauses. The first day of the semester is defined as the first day of general class commencement and is usually after the main Orientation. Refunds are made in accordance to the following table: Submission of Written Notice of Withdrawal Percentage of Refund More than 30 calendar days BEFORE the first day of classes in the semester. 80% of tuition fees Within 30 days BEFORE the first day of classes in the semester and up to 7 calendar days AFTER the same new semester. 75% of tuition fees Refund requested within the second week of the new semester (7th - 14th calendar days ). 50% of tuition fees Refund requested AFTER the second week ( 14 calendar days) of the new semester. DIAGRAMMATIC SUMMARY OF REFUND 1st day of Classes (New Semester) 30 days 80% Refund No Refund 7 days 75% Refund 7 days 50% Refund No Refund 4. Nilai University reserves the right to utilise Refundable Deposits to offset outstanding amounts due to the University in the computation of refunds. 5. In the event that a refund is requested after the enrolment of subjects is done and the fees due are but not paid, Nilai University reserves the right to charge the fees accordingly and utilise Refundable Deposits to offset the outstanding amount due to the University in the computation of fees. 6. It is imperative for me to obtain the acknowledgement of Nilai University authorities in my submission of request for refund in order to ensure that the University receives my written request via the Withdrawal / Completion Form, including and particularly the date of submission and acknowledgement of receipt of the submission. 7. The request for refund should only be made via Nilai University’s Withdrawal / Completion Form and that other methods of notification will not be entertained. Any amount to be refunded are subject to the approval and discretion of the University. 8. In the event I drop any subjects before the ADD/DROP deadline and subsequently follow up with a withdrawal from Nilai University, the University will charge the full fees based on the initial Approved Course Enrolment. 9. Nilai University will refund the Caution Fee and Accommodation Deposit (if applicable). However, this is provided that no rules or regulations have been breached and I do not have any outstanding fee with the University. 10. In the event of graduation or in the event of a withdrawal the respective forms must be submitted within a maximum of 2 semesters from the event for refundable deposits as per clause 9 above. 11. At all times, it is imperative that all rules and regulations are strictly adhered to, failing which Nilai University shall forfeit all refundable deposits and the said deposits may be required to be paid once again, where applicable. 12. In the event that I fail to settle my fee in accordance to the respective due date, I shall be liable to pay late payment charges that shall be levied accordingly by Nilai University. 13. I will abide to all rules and regulations as stipulated in the Nilai University student handbook. B. APPLICABLE TO INTERNATIONAL STUDENTS ONLY Initial 1. I hereby agree to submit my Application Form, Application Fee and all fees due to the Education Malaysia Global Services (EMGS) necessary for Visa application processing. In the event that my application is rejected by the relevant Malaysian authorities, the aforementioned fees will not be refunded. 2. I have been adviced to take a Pre-Arrival Medical Test (not compulsory) to be submitted (with the Lab Test & Doctor’s Reports) together with this Application Form to certify that I am fit for the programme. I have been adviced that this is a pre-caution to ensure that I meet Malaysia’s Guidelines for Certification of Foreign Student’s Health which can be downloaded at http://www.educationmalaysia.gov.my/our-services/by-type-of-services/medical-screening-for-international-students as a medical screening will be performed in Malaysia upon my arrival by panel clinics/ hospital before I am endorsed with a student visa. In the event I do not pass the medical screening, I understand that I will be required to return to my country. 3. I hereby agree to remit with immediate effect all initial tuition fees to Nilai University upon notification of my visa approval prior to arriving in Malaysia. 4. In the event that my studies are terminated by Nilai University on account of criminal offence, felony, violation, fraud, indiscipline, misconduct, misdemeanor requiring police intervention, consecutive and serious examination cheating, continuous plagiarism and / or related grounds, I understand that my fees will not be refunded. In such circumstances, the University reserves the right to utilise any fees paid and / or refundable deposits to offset the cost of deportation, including the purchase of air fare and cost of transportation to the airport. 5. In the event that no deportation is required, Nilai University reserves the right to forfeit all fees paid including all refundable deposits. Initial J. DECLARATION BY STUDENT 1. 2. I hereby declare that all information herein provided is complete, accurate, and true to be the best of my knowledge. I hereby agree that, 2.1 Nilai University reserves the right to verify the same and I also agree that the University reserves the right to vary or reserve any decision in respect of my application in the event that the said information is found to be false, incorrect or incomplete. 2.2 In the event that Nilai University shall forfeit the said fees, I shall not have any claim whatsoever against the University. 3. 4. I also agree that Nilai University reserves the right to alter, amend, change or modify the current published fees and all fees payable shall be the published fees at the time of payment. I hereby understand and / or agree that, 4.1 All personal data information that are collected on this form and during my enrolment in order to meet Nilai University’s obligation under ACT 555; Private Higher Educational Institution Act 1996; to ensure student compliance with the immigration obligation under Malaysian Immigration requirement generally; and that the University can release the information provided to and not limited for the purpose of verifying qualifications and checking references, financial standing, immigration status or any action similar or relevant in nature; 4.2 Nilai University, hereby reserves the right to make use of the said personal data information by me, its related companies or selected parties; 4.3 I would not hold Nilai University liable for any breach or unauthorised use / access or any loss or damage suffered as a result hereof. 5. I acknowledge that all documents submitted become the property of Nilai University. 6. I hereby understand and agree that it shall be my responsibility to know and abide with all relevant and applicable rules and regulations of Nilai University. Signature Date K. TO BE SIGNED BY PARENT / GUARDIAN / SPONSOR IF STUDENT IS UNDER THE AGE OF 18 Name : Relationship : Date : Signature L. CHECKLIST Malaysian Applicants International Applicants Completed Student Application Form Completed Student Application Form Completed Accommodation Form (if accommodation is required ) Completed Accommodation Form 2 Certified True Copies of High School Results / Transcripts & Certificates 2 Certified True Copies of High School Results / Transcripts & Certificates (certified translated copies are required if it is not in English language) 3 Passport Size Photographs 2 Full set Copies of Passport (inclusive of covers ) Application Fee 10 Passport Size Photographs (blue background only) Certified True Copy of IC Certified True Copy of SPM / O-Levels / STPM / A-Levels / UEC / SAM / CPU Certified True Copy of MUET / IELTS / TOEFL Medical Examination Form & Lab Test Report No Objection Certificate (NOC) (For Sub-Saharan Countries Only) RM600 Application Fee Letter of Declaration from Commissioner of Oaths / Embassy for the discrepancy of name in the academic transcript and passport Release Letter with the academic results and attendance record For office use Counsellor : Amount Paid : Date : Receipt No : Please submit the completed Student Application Form to: NILAI UNIVERSITY Marketing Department No. 1, Persiaran Universiti, Putra Nilai, 71800 Nilai, Negeri Sembilan Darul Khusus, Malaysia Tel: +60 6 850 2308 Fax: +60 6 850 1266 SMS: +6 012 628 1139 E-mail: marketing@nilai.edu.my Website: www.nilai.edu.my KPT/JPT/DFT/US/N02 307215-P V1-03-14