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CGS-750-001-QR-01 Ver.

Jan 2013 UNIVERSITI TENAGA NASIONAL COLLEGE OF GRADUATE STUDIES

APPLICATION FORM FOR ADMISSION INTO POSTGRADUATE PROGRAMMES

COGS REF. NO.: ____________ SEMESTER __________SESSION_______________

INSTRUCTIONS TO APPLICANT Please attach a passport sized photograph


1. Fill out this application form and submit at COGS counter together with supporting documentation and application fee to the College of Graduate Studies, Universiti Tenaga Nasional, Jalan IKRAM-UNITEN, 43000 Kajang, Selangor 2. Please refer to the application check list and ensure that the copies of documents needed are sent to the COGS.

A.

DETAILS OF CANDIDATURE (Please choose () only one in the appropriate box) Semester May September Year : ____________ Structure A (Full Research) B (Coursework & Research) C (Coursework & Project)

Candidature Full-time Part-time

Programme Ph.D in Engineering (A) Ph.D in Industrial Science (A) Ph.D in Information & Communication Technology (A) Ph.D in Business Management (A) Master of Electrical Engineering (A/B) Master of Mechanical Engineering (A/B) Master of Civil Engineering (A/B) Master of Industrial Science (A/B) Research Title (Structure A only)

Master of Information Technology (A/B) Master of Business Administration (C) Master of Engineering Management (C) Master of Communication Systems Engineering(C) Master of Electronics Systems Engineering (C) Master of Science in Management (A) Master of Science in Accounting (A) Master of Science in Finance (A)

Note: if you are applying into Structure A (by Research) programme, you are required to attach your research proposal. This should contain your research problem formulation, literature review, conceptual framework, methodology, managerial implication and key references. If the research proposal is found to be a copy or plagiarized from other sources. The application will be rejected FOR UNIVERSITY USE ONLY (Please tick () in the appropriate box) Applicant Name : Entry Qualification Acceptable English Language Acceptable Recommendation Committee Meeting Date Proposed Supervisor (Structure A only) Comment/Action Yes Yes Accept No No Reject

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B. PERSONAL DETAILS Name : (Name should be written in upper case letters and as it would appear on the identity card / international passport) Identity Card No. or Passport No.: Email : Nationality : Religion : Gender : Male / Female Place of Birth: (Malaysia only) Ethnicity : Malay / Chinese / Indian Others (please state): Age : Date of Birth: (Day/Month/Year) Marital Status : Single / Married Mobile Phone : Telephone : Fax No. : Correspondence Address: (complete Mailing Address with Postcode)

Permanent Home Address: (complete Mailing Address with Postcode)

Person to be Contacted in Case of an Emergency Name : Address :

Mobile Phone : Telephone : Fax No. : Email :

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C. ACADEMIC AND PROFESSIONAL QUALIFICATIONS Name of Institution: Country of Study : Major Field of Study : Qualification Obtained : Dominant Medium of Instruction: e.g. English / Arabic / Malay etc Name of Institution: Country of Study : Major Field of Study : Qualification Obtained : Dominant Medium of Instruction: e.g. English / Arabic / Malay etc Name of Institution: Country of Study : Major Field of Study : Qualification Obtained : Dominant Medium of Instruction: e.g. English / Arabic / Malay etc Results Achieved: Average grade point. E.g. CGPA out of 4 or % Graduation Date : (years/months) Duration of Study : (No. of years/months) Results Achieved: Average grade point. E.g. CGPA out of 4 or % Graduation Date : (years/months) Duration of Study : (No. of years/months) Results Achieved: Average grade point. E.g. CGPA out of 4 or % Graduation Date : (years/months) Duration of Study : (No. of years/months)

Note: Please enclose certified copies of degree certificates and degree transcripts as evidence above Professional Qualification (if any) Qualification obtained

Year awarded

Awarded by

Note: Please enclose certified copy of professional qualification certificates D. ENGLISH LANGUAGE PROFICIENCY QUALIFICATION Name of Examination/Test : Competency Level/Band Score TOEFL / IELTS Year Taken:

Note: Please enclose certified copy/ evidence of Competency level achieved in either TOEFL/IELTS

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E.

BRIEF FULL-TIME EMPLOYMENT SUMMARY

Current position and Area of Responsibility:

Name and address of organization currently working at:

Telephone:

E-mail :

Date From: Duration of working with current employer: (month/year) (month / year) Previous Position: (work experience after degree, if any) Name of Date From Job Title or Position Held Company/Organization (Month/Year)

Date To (Month/Year)

Length of Service

F.

FINANCIAL SUPPORT (Please tick () in the appropriate box) I am fully sponsored by my employer/home government (Please enclose official letter(s) of financial Guarantee from your sponsoring institution) Name of Sponsor:

I am a private student supported by my family/ self funding (Please complete and submit the Financial guarantor form COGS/FINANCE together with financial statement e.g. Bank statement, EPF statement etc.)

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G. REFEREES (Name two (2) referees. For applicants into the doctorate and masters programme, both referees should be somebody who is capable of reporting your performance. Immediate family members do not qualify as referees.). Referee 1 Name Position Referee 2

Address

Phone No. Fax No. E-mail

(Please complete and submit the Referees Report form COGS/REFEREES. Recommendation letter not acceptable) H. DECLARATION I, the undersigned, declare that I have read and understand that all information and documentation provided in the application are, to the best of my knowledge, true and complete. I understand that any false statement or omission, even if unintended on my part, may result in a delay or a rejection of my application. Finally, if I am offered and accepted to enroll in the postgraduate programme, I agree to abide by the rules and regulations of College of Graduate Studies, Universiti Tenaga Nasional. Name: .... Signature of Applicant . Date: (Please note that forms without the signature of the applicant will not be considered complete and hence will not be processed)

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REFEREES REPORT 1 (Recommendation letter not acceptable)

This report is confidential and must be sealed by the referees and forward to the applicant Part A : TO BE COMPLETED BY THE APPLICANT Name Programme Mode of study Programme structure : : : : FULL TIME A B PART TIME

COGS/REFEREEE S

Part B : TO BE COMPLETED BY THE REFEREE Name Position Employers Name Employers Address Telephone No. Email Part C : REFEREES REPORT How long have you known the applicants ? (No. of years) : ___________________________ How do you know the applicant? What is your relationship with the applicant? In your opinion is the applicant ready for graduate work? Why:_______________________________________________________ Excellent Intellectual Ability Maturity and emotional Stability Motivation General knowledge Initiative Team Player Responsibility Your Recommendation Recommended Not Recommended Very good Good Average Poor Yes No : : : : : : Fax No. :

Date : __________________

Signature & Official stamp : ________________________

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REFEREES REPORT 2 (Recommendation letter not acceptable)

COGS/REFEREE

This report is confidential and must be sealed by the referees and forward to the applicant Part A : TO BE COMPLETED BY THE APPLICANT Name Programme Mode of study Programme structure : : : : FULL TIME A B PART TIME C

Part B : TO BE COMPLETED BY THE REFEREE Name Position Employers Name Employers Address Telephone No. Email Part C : REFEREES REPORT How long have you known the applicant? (No. of years) : ___________________________ How do you know the applicant? What is your relationship with the applicant? In your opinion is the applicant ready for graduate work? Why:_______________________________________________________ Excellent Intellectual Ability Maturity and emotional Stability Motivation General knowledge Initiative Team Player Responsibility Your Recommendation Recommended Not Recommended Very good Good Average Poor Yes No : : : : : : Fax No. :

Date : __________________

Signature & Official stamp : ________________________

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COGS/FINANCE
FINANCIAL GUARANTOR

I agree to be the guarantor of the student name: _________________________________________________________________________________ NRIC or Passport No.: ____________________________________________________________ During the period of study for his/her degree (name of programme): _________________________________________________________________________________ at Universiti Tenaga Nasional, Malaysia. I agree to assume all financial responsibility should my source(s) of funding be interrupted or stopped. My particulars are as follows: Name : NRIC or Passport No. : Occupation : Home Address : Telephone No. : Fax No. : Email Address : Employers Address : Employers Telephone No. : Fax No. : Email Address :

Date : __________________________ Signature :

Guarantors Name : __________________________

Note: Please enclose FINANCIAL STATEMENT e.g. BANK STATEMENT, EPF STATEMENT etc 8|Page

Applicant Checklist
Please tick () the following items, before you submit the application form ALL COPIES OF CERTIFICATES AND DOCUMENTS MUST BE CERTIFIED TRUE COPIES Application Form Malaysian & International Malaysian International Academic transcript(s) Malaysian International Academic certificate(s) 1 copy (if it is not in English it should be certified translated and certified true copy) 3 copies International (if it is not in English it should be certified translated and all documents must certified true copy by the Embassy) PHD APPLICANT 1 copy of Postgraduate & Undergraduate Academic transcript and certificate (Certified true copy) Identity Card Malaysian Malaysian Passport International color photograph Malaysian International TOEFL or IELTS certificate International COGS Forms Malaysian & International Malaysian & International Other Malaysian & International 1 copy Financial Guarantor form with Bank account statement or EPF statement / Sponsorship letter 2 Referees Report form (Please use our form and recommendation letter not acceptable) Research proposal (Structure A only) 1 passport size color photograph (3.5cm x 5cm) 3 passport size photograph with BLUE background (3.5cm x 5cm) 3 copies of ALL pages of passport with certified by the Embassy -A passport that is valid at least 24 months from the expected date of entry 1 copy (Certified true copy) 1 copy (if it is not in English it should be certified translated and certified true copy) 3 copies (if it is not in English it should be certified translated and all documents must certified true copy by the Embassy) completed and signed

Processing Fee A postal / Money Order / Receipt from Finance Department RM30.00 RM120.00

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