NON-RESIDENT FORM

FOR OFFICE USE ONLY

FIRST TIME APPLICATION APPEAL
REJECT APPROVE Appeal letter Supporting
Room Attached: documents
P Remark: _____________________________
Remark: REJECT APPROVE
________________________________________ Room Attached:
________________________________________ P

A) CONDITIONS FOR STUDENTS APPLYING TO STAY OFF CAMPUS

1) Married Couple (Attach a copy of marriage certificate) Kindly Attach
2) Health problem (Attach the latest medical report) Supporting Documents
3) Final semester students who undergo Hafazan/Usrah/Koko or are in the
process of completing the thesis (Attach an application letter certified and 1) Application Letter
stamped by the Faculty Head of Department)
4) Practical Training students (Attach an application letter certified and 2) Copy of current
stamped by the Faculty Head of Department) CGPA Result
5) Student who live with parent within 10km radius and possess CGPA not
lower than 3.00 (Attach an application letter by the parent of student, a copy 3) Copy of next
of electricity/water bill and current semester result that certified and stamped Semester course
by the Faculty Head of Department) (Special Case)
 6) International Students (Attach an application letter by that certified and
stamped by the Faculty Head of Department
REMINDER:
- Incomplete applications will be REJECTED
B) PARTICULARS OF APPLICANT
Name

Matric No Programme

Passport /I.C No Nationality Gender

Male / Female
Current Address (Out-Campus Address)

Tel No. - H/P -

Name of Parent / Guardian

Tel No. - H/P -

C) STUDENT'S DECLARATION
OFF CAMPUS STUDENT PLACEMENT TESTIMONIAL
I, ……………………………………………………. with I.C. / Passport number ………………………
and matric no ……………………….. hereby promise to :
1. Make check out process within 1 week upon approval of staying off campus and I understood that the
approval will be considered VOID if I fail to check out within the time given.
2. Maintain the good name of the college.
3. Follow all the rules and regulations as made by the college.
4. Paticipate in all activities organised by KUIS / BKPM.
5. Be ready to face disciplinary actions if I violate any of the rules and regulations as set by the college
as and when I stay off campus.

Applicant's Signature:

Date :
Signature

D) MENTOR
The Student Placement and Accommodation Division seeks the cooperation of the CGPA
mentor to evaluate, advise and guide the students to make the right decision with regard
to the choice of accomodation before approving their applications.

Comment :

Date :
Signature

*** If the the form is submitted without any comment/review or official stamping, the application will be rejected.

E) DEAN

Comment :

Date :
 Signature

*** If the the form is submitted without any comment/review or official stamping, the application will be rejected.