UNIVERSITY OF WALES

Masters in Business Administration

APPLICATION FOR ADMISSION

A. PERSONAL DETAILS
1.

FULL NAME _______________________________________________________________________________

(PLEASE UNDERLINE YOUR SURNAME OR FAMILY NAME)

2.

HOME ADDRESS ___________________________________________________________________________

____________________________________________________________________________
____________________________________________________________________________
TELEPHONE NUMBER _____________________________________
HANDPHONE NUMBER _____________________________________
EMAIL ____________________________________________________

3.

COMPANY NAME __________________________________________________________________________

ADDRESS _________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
TELEPPHONE NUMBER _____________________________________
FAX NUMBER _______________________________________________

4.

CORRESPONDENCE ADDRESS ______________________________________________________________

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
TELEPHONE NUMBER _____________________________________

5.

SEX ___________________

6.

DATE OF BIRTH

AGE ____________
DAY

7.

MARTIAL STATUS_____________________

MONTH

YEAR

PLACE OF BIRTH _________________________________________________________________________

NATIONALITY _________________________________________________________________________

B. ACADEMIC AND PROFESSIONAL QUALIFICATIONS

(2 certified copies of certificate and degree together with transcripts must be attached)
8.

TERTIARY EDUCATION

Year
Start

9.

University/College

Major In

Degree

Honours

Finish

PROFESSIONAL/OTHER QUALIFICATIONS

Year

Professional Body

Examination

Stage

10. OTHER COURSE ATTENDED

Year

Course Title

Duration

Organization
Conducting

C. DETAILS OF EMPLOYMENT
(Please give details of any employment, with date, excluding periods of casual employment)
11. PRESENT EMPLOYMENT

Position:
Organization:

Since:

Brief Description of Duties and Responsibilities:

12. PREVIOUS EMPLOYMENT

Year
From

Organization
To

13. NON-ACADEMIC INTEREST:

Position

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

D. FINANCIAL PROVISION FOR COURSE

14. Are you sponsored by any organization?
If Yes, please state name of organization:

Yes/No

____________________________________________________________________________________
If no, please state source of finance:
____________________________________________________________________________________

E. PAYMENT OPTION
15. Payment Mode
Cash
Cheque/money order/bank draft
Credit card ( visa / master)
Card No. ____________________________________________________ Expiry Date: ________________
Cardholders Signature: _______________________________________ Date: ______________________
FOR OFFICE USE ONLY
DATE

AMOUNT

CASH/CHEQUE NO.

RECEIPT NO.

REMARKS

STAFF SIGN.

F. APPLICATION DETAILS
16. Reference
Please give the names and addresses of 2 referees from whom you have requested references

A.

B.

Tel:

Tel:

16. Please indicate how you came to know about the course you are applying.

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
17. Declaration
I hereby apply for admission to the University of Wales Programme. I declare that the information
given in this form is true and correct, and if accepted as a student, I will comply with the conditions,

rules and regulations of the University and all fees paid are not refundable nor transferable.
Applicants Signature: ________________________________________ Date:
Applicants N.R.I.C. /Passport No.:______________________________________

18. Check List

The completed application form must be accompanied by the following items:
a.
2 certified copies of degree, certificate and transcript or 2 copies of resume.
b.
1 letter of reference
c.
3 passport-size photographs
d.
2 photocopies of IC
e.
Application fee of RM100 (non-refundable).
f.
Cheque should be crossed in favour of KOLEJ KASTURI .
The complete application should be returned to:

Programme Director - UOW

Kolej Kasturi
11th Floor, Plaza First Nationwide,161, Jalan Tun H.S. Lee,
50000 Kuala Lumpur. Malaysia
Tel: +603 2032 3001 Fax: +603 2031 3228 Email: uow@kasturi.edu.my