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No.

Perakuan Institusi: KPT/JPS/DFT/US/K05

Please affix a
passport-sized
photograph
here

UNDERGRADUATE PROGRAMMES APPLICATION FORM


Instructions:
1. Applicants must ensure that all admission requirements are met before submitting an application. Please contact our Student
Recruitment Officers, at 604-4298000/visit our website @ www.aimst.edu.my if you are unsure of your eligibility to apply.

2. A processing fee of RM100(Malaysian)/USD150 (International) made payable to ‘AIMST Sdn. Bhd.’ must be enclosed. All processing
fees are NON-REFUNDABLE regardless of the outcome of the application.

3. The original or officially certified transcripts and certified copies of diplomas/certificates of academic qualifications must be sent along
with this application. Documents not in English should be accompanied by a formal certified translation in English acceptable to the
University. Applicants should also provide documentary evidence certifying their professional qualifications, if any. Photocopies of
documents not properly certified will not be accepted.

4. a) Malaysian students should include a certified true copy of Identification Card (I.C.) when applying for AIMST programmes.

b) International students should include a certified true copy of Passport (all pages including empty ones) when applying for AIMST
programmes.

5. TWO (Malaysian)/EIGHT (International) passport-sized photographs must be enclosed.

6. Please use BLOCK LETTERS and write in BLACK ink. Please use additional sheets if space provided is insufficient.

1. PPRGRAMME(s) APPLIED Please tick & write preference level e.g. 1st, 2nd & 3rd
Preferance Level
Medicine & Health Sciences

MBBS (5 years) (KP(JPS)/(A3249)05/10)


B. Dental Surgery (5 years) (KP(JPS)/(PA5321)09/10)
B. Pharmacy (4 years) (KP(JPS)/(PA6201)09/09)

Information Technology (3 years)

BIT (Hons) Management (KP(JPS)/(A1655)05/11)


BIT (Hons) in Information Systems (KP(JPS)/(A1653)05/11)

Applied Sciences (3 years)

BSc (Hons) Biotechnology (KP(JPS)/(A1654)10/11)


BSc (Hons) Materials Technology with Management (KP(JPS)/(A1656)03/12)

Engineering (4 years)

BEng. (Hons) in Electrical and Electronic (KP(JPS)/(PA4271)06/08)

Bussiness & Management (3 years)

BSc (Hons) in Management Information Systems (KP(JPS)/(PA1653)04/09)


BSc (Hons) in Bussiness and Marketing (KP(JPS)/(PA4798)04/09)
BSc (Hons) in Finance and Management (KP(JPS)/(PA4797)04/09)
2. PERSONAL DETAILS

Title: Mr Mrs Others ……………….. NRIC/Passport No.:

Name: (as in NIRC/Passport)

Correspondence Address: Nationality:

Race: Religion:

Date of Birth:

Gender: Male Female

Home Tel:

Home Fax:

Mobile Phone:

E-mail:

3. PARENTS/GUARDIAN DETAILS

3.1 Father/Guardian

Title: Dr Mr Others ....................

Name: (as in NRIC/Passport)

Correspondence Address: Home Tel:

Office Tel:

Mobile Phone:

Employer: E-mail:

Occupation: Annual Income:

3.2 Mother

Title: Dr Mr Others ....................

Name: (as in NRIC/Passport)

Correspondence Address: Home Tel:

Office Tel:

Mobile Phone:

Employer: E-mail:

Occupation: Annual Income:

3.3 Invoices and Examination results should be sent to :

Father/Guardian Mother

3.4 Emergency contact (Other than parents/guardian) :

Title: Dr Mr Mdm Mrs Ms Others ....................

Name: (as in NRIC/Passport)

Correspondence Address: Relationship:

Home Tel:

Office Tel:

Mobile Phone:
4. ACADEMIC QUALIFICATIONS: please tick (√)

4.1 SPM/O-level qualification

Institution: Year taken:

Subject Grade
1. ____________________________________ ________________
2. ____________________________________ ________________
3. ____________________________________ ________________
4. ____________________________________ ________________
5. ____________________________________ ________________
6. ____________________________________ ________________
7. ____________________________________ ________________
8. ____________________________________ ________________
9. ____________________________________ ________________
10. ____________________________________ ________________

4.2 Other qualifications

AIMST Foundation in Science STPM A-Level SAM CPU MUFY HSC CIMP

UEC Others, please specify ....................

Institution:

Subject Grade
1. ____________________________________ ________________
2. ____________________________________ ________________
3. ____________________________________ ________________
4. ____________________________________ ________________
5. ____________________________________ ________________
6. ____________________________________ ________________
7. ____________________________________ ________________
8. ____________________________________ ________________
9. ____________________________________ ________________
10. ____________________________________ ________________

4.3 English Language Achievement

Institution:

Examination Year Grade

1. IELTS
2. TOEFL
3. English 1119
4. MUET
5.____________________________
6. ____________________________

5. SOURCES OF FUNDING

5.2 Financial Support

Self Sponsored Sponsored (please attach supporting document) Others (please specify) ...........................

6. ACCOMMODATION

It has been made MANDATORY for ALL student to stay in University Student Residences at Semeling Campus in their first 2 years of study
in AIMST.
7. DECLARATION

Parent/Guardian

I, .......................................................................... hereby agree to pay all fees due to AIMST on behalf of the above applicant in accordance with
the policies of AIMST. I also agree to the fees stated in Fees Structure and terms of the Refund Policy of AIMST on fees, a copy of which
will be given at the time of registration.

Signature of Parent/Guardian: Date:

Applicant

I declare that all the information stated in this application is true and correct. I understand that AIMST reserves the right to vary any
decision regarding admission or enrolment made on the basis of incorrect or incomplete information. I agree to abide by all the academic
and administrative regulation of AIMST.

Signature of Applicant: Date:

* AIMST will officially notify you of the outcome of your application. Please take note that submission of the application does not constitute
acceptance into the university.

FOR OFFICE USE ONLY


Student Recruitment Division

Recommended by Agent/Student Documents Complete Counselled by.

Documents required (please specify) ………


………………………………………
Signature Promotion Scheme:
Name: 1. __________________________________ ……………………………………
Date: 2. __________________________________ Signature
3. __________________________________ Name:
4. __________________________________ Date:

Finance and Account Division

Application Fees Enclosed: Bankers Cheque/Bank Draft No.: …………………… ……………………………………


Cash: RM …………………………………………….. Signature
Others: ………………………………………………. Name:
Date:

Student Admissions and Records Division

Documents Complete ……………………………………


Documents required (please specify) ........................................ Signature
Name:
Remarks: Date:

Selection Committee/Dean

Admission Status Firm Offer KIV Rejected

Rejected: (reasons for not supporting this application)

Conditional Offer (please specify) ……………………………………


Signature
Name:
Date:

Please return this form to:

Student Recruitment Division


AIMST UNIVERSITY
Semeling, 08100 Bedong, Kedah Darul Aman, Malaysia

For more information please contact:

Tel: 604-429 8000


Fax: 604-4298007
E-mail: chooseaimst@aimst.edu.my
www.aimst.edu.my

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