STUDENT APPLICATION FORM
FOR FOUNDATION AND UNDERGRADUATE PROGRAMME
(FOR FOREIGN STUDENT - NON MALAYSIAN CITIZEN)
Affix Passport-sized
Photo
HOW TO COMPLETE THIS APPLICATION FORM
1. Please use black or blue ink pen only and write clearly using CAPITAL letters only.
2. All sections must be completed. Please indicate as NA for sections that not applicable.
3. Enclose one set of supporting documents that have been certified by recognised
authorities, e.g. original issuing body. Supporting documents will NOT be returned.
This application form remains the property of UTP.
Note: This application will not be processed unless complete supporting document is attached
A
PERSONAL INFORMATION
NAME
DATE OF BIRTH - DD/MM/YYYY
AGE
GENDER-Please mark "X"
MARITAL STATUS-Please mark "X"
MALE
FEMALE
PLACE OF BIRTH
SINGLE
MARRIED
PASSPORT/ID NO
NATIONALITY
HOME PHONE- Country Code/Area Code/Number
CONTACTS
Please place each dot '.' and the @ symbol in its individual box
EMAIL
HOME
ADDRESS
B
FAMILY INFORMATION - Parent or Guardian
NAME
RELATIONSHIP
NATIONALITY
CONTACTS
Please place each dot '.' and the @ symbol in its own box
EMAIL
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DIVORCED
OTHER
C
PROGRAMME APPLIED FOR
FOUNDATION
UNDERGRADUATE
1
PLEASE TICK (X) IN THE APPROPRIATE BOX
2
3
PROGRAMME PREFERENCE
PLEASE USE THE FOLLOWING PROGRAMME CODE FOR ABOVE SECTION :
CV00 - CIVIL ENGINEERING
ENGINEERING
D
TECHNOLOGY
ME00 - MECHANICAL ENGINEERING
CH00 - CHEMICAL ENGINEERING
EE00 - ELECTRICAL AND ELECTRONICS ENGINEERING
PE00 - PETROLEUM ENGINEERING
GS00 - PETROLEUM GEOSCIENCE
CO03 - INFORMATION AND COMMUNICATION
TECHNOLOGY
CO04 - BUSINESS INFORMATION SYSTEM
SCIENCES
AP00 – APPLIED PHYSICS
AC00 – APPLIED CHEMISTRY
ACADEMIC QUALIFICATIONS INFORMATION
EDUCATIONAL HISTORY
NO
NAME OF SCHOOL/COLLEGE/UNIVERSITY
BEGIN - MMYY
END - MMYY
DEGREE/DIPLOMA/CERTIFICATE
1
2
3
4
5
6
E
QUALIFICATION DETAILS - Please list down SUBJECTS of your recent/highest qualification
NO
DEGREE/DIPLOMA/CERTIFICATE
SUBJECT OR UNIT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
PLEASE WRITE IN SEPARATE PAPER(FOLLOWING THE ABOVE FORMAT) IF SPACE PROVIDED IS NOT ADEQUATE
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GRADE/MARK
F
HEALTH INFORMATION
Have you ever been diagnosed of having any critical disease?
NO
YES, if YES please specify
Are you physically disabled?
NO
G
YES, if YES please specify
DECLARATION
I, hereby declare that all information furnished above are accurate and TRUE to the best of my belief. I also understand
that Universiti Teknologi PETRONAS (UTP) has the right to reject this application or revoke the admission offer to UTP
at any time should the information, certificates and relevant documentation furnished are found to be inaccurate and/or
UNTRUE.
Date:_______________________
H
Signature: ________________________________________
APPLICATION CHECKLIST
Have you:
Completed the application form and signed it
Attached copy(ies) of passport and/or identity card
Attached most recent passport sized photos
Attached all relevant secondary and/or tertiary academic transcript and certificates
Application fee of USD 30.00 in the form of banker's cheque payable to Universiti Teknologi PETRONAS
Note: Only completed application form which is attached with the required documents will be given due consideration.
Please forward your application (softcopy/scanned version) to UTP Undergraduate Admission: [email protected] and
hardcopy to below address.
Admission and Registration Unit,
Universiti Teknologi PETRONAS,
32610 Bandar Seri Iskandar,
Perak, Malaysia
(Attn: International Student Admission)
I
ENTRY REQUIREMENTS
FOR FOUNDATION PROGRAMMES
1) ENGINEERING PROGRAMMES AND PETROLEUM GEOSCIENCE :
~ O-Level or Equivalent : Pass O-Level with at least five (5) Credits (Grade C and above) inclusive of Mathematics, Physics,
Chemistry AND any two (2) other subjects.
2) TECHNOLOGY PROGRAMMES:
~ O-Level or Equivalent : Pass O-Level with at least five (5) Credits (Grade C and above) AND at least Grade C in Mathematics, AND
any two (2) other non-language subjects.
FOR UNDERGRADUATE PROGRAMMES
1) ENGINEERING PROGRAMMES AND PETROLEUM GEOSCIENCE :
~ A-Level or Equivalent : Pass A-Level with at least Grade C in Mathematics, Physics and Chemistry
2) TECHNOLOGY PROGRAMMES:
~ A-Level or Equivalent : Pass A-Level with at least Grade C in Mathematics and any two (2) non-language subjects.
ENGLISH REQUIREMENTS
a) IELTS - score of 6.0; OR
b) TOEFL - paper-based score 550 or equivalent
Note:
The University reserves the right to alter or discontinue its programs as required. The entry requirement stated on this application form should be used
as a general guideline for admission only, the University may change these requirements at any time.
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