附件二 北方大学交流生申请表.pdf

CENTRE FOR INTERNATIONAL AFFAIRS AND COOPERATION (CIAC) Please attach a passport size photo here STUDENT EXCHANGE PROGRAM APPLICATION FORM (Inbound) This application is for students who are applying to the Universiti Utara Malaysia as part of a specific exchange agreement between the Universiti Utara Malaysia and a partner institution. Application will not be assessed without the signed endorsement of the partner institutions International Office. Personal Details Full Name: Date of Birth: (as appear on the passport) / dd / mmm / / yyyy Address: Street Address Apartment/Unit # City State Phone No.: ( Sex: Male Handphone No.: ) ( ZIP Code E-mail Address: ) Female Nationality: Passport No.: Passport Expiry Date: Place of Issue: Academic Details Name of University: Name of Current Degree: Major Field of Study: Degree start date: / (dd/mmm/yyyy) Expected Degree Completion date: (dd/mmm/yyyy) / / Current Semester: Current CGPA: / Commencement Details 1 semester Year: Starting Semester: 1st Semester (September) 2 semesters Length: 2nd Semester (February) English Proficiency Please indicate below your current English proficiency and attach certified copies of your test results if required. If NO, provide the results from one of the following English No Yes First language is English: tests IELTS Overall Band TOEFL Score and Type of Score: Test: Other English Proficiency test accepted by partner University. Other Documents A copy of your English proficiency test (if applicable) Certified copy of your academic transcript (in English) Passport size photograph A copy of the information page of your passport Course Registration Year: Semester 1 (September - January) Course Code …tini / mobility/form Course Name Unit / Credit Hours Year: Semester 2 (February - August) Declaration I declare that the above information is correct, and I understand that admission to Universiti Utara Malaysia as an exchange student does not entitle me to be awarded a qualification from the Universiti Utara Malaysia. I agree that all information given is true and I will return back to my home university after completing my exchange program at Host University. I also understand that I am subject to all the rules and regulations at host University while I’m studying at Host University. Signature: Date: This application is to be approved and submitted by your International Office This application is submitted by the University’s registered students. Name of International Office officer: Position: Signature: Date: This application must be completed and sent to: Universiti Utara Malaysia Offshore Office (China) Add: 413,Qinglan Plaza, No.24 Dongsishitiao Dongcheng Dist., Beijing, P.R.China Tel: 86 10 51650127 64035227 Fax: 86 10 64032524 Email:prchina@uum.edu.my www. uum.edu.my …tini / mobility/form