Form A
Application Form for Graduate Studies Programme
(Masters / PhD)
A. Your personal and contact details. Please type or write clearly in CAPITAL LETTERS. Mark
Applicant’s Name (as it
Passport
sized photo
where appropriate.
appears on your Identity
Card/Passport)
Colour
Identity Card /Passport
Number
(Brunei IC
only)
Yellow
Red
Green
Nationality
Gender
Male
Female
Race
Religion
Marital Status
Single
Married
Contact
no.
Email
Date/Country of Birth
Address (Home)
Postcode:
Correspondence
Address (if different from
home address)
Postcode:
Name:
Next of Kin (the person to
Relationship:
contact in case of emergency)
Contact No.:
B. For International Applicants
Country of birth
Country of domicile (the country you live in)
Do you require a student visa to study in
Brunei?
Yes
No (If yes please provide a copy of your passport)
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Yes
No
If yes, please list the course you have studied including any English Language
courses, the type of visa and when the course started and ended. Please
provide supporting certificates/ transcripts and copies of your visa. Please
continue on a separate sheet if necessary.
Have you previously studied in Brunei
Darussalam?
Course title:
Name of institution/university/school:
Course start/end date:
Level ( e.g. BA, BSc, MA):
Type of visa (please include copies):
C. Programme Details
Type of programme:
Taught Masters
Research Masters
Mode of study
Full Time
Part-time
Proposed start date
January
August
PhD
Year:
Programme Area
Course Title
Award
MA
MSc
MEng
PhD
Proposed research topic
(for Research Programme only)
If you are a member of staff at Universiti Teknologi Brunei (UTB) or you have attended or are presently attending a course at
UTB, please provide Staff ID / Student Roll Number:
D. Financial Information
Please mark
the relevant box and state how you intend to pay for your studies
Brunei Government Scholarship
Age on 1st September:
Other Scholarship (Please specify):
Ref. Letter:
Date:
Employer
Ref. Letter:
Date:
In-service Training
Ref. Letter:
Date:
Self-funded
Others (Please specify):
E. English Language
Is English your first language?
Yes
No
Was English the language of instruction for your
first degree?
Yes
No
Score
Date obtained
IELTS
Please provide details of your English Language
qualifications with results obtained and the date.
TOEFL
O Level GCSE
Other (please specify):
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F. Education – Please give full and accurate details of your relevant education background starting from the most
recent.
Date of award
Awarding institution/body
Course title
Result
G. Work experience – Your application may be considered on the basis of your work and other relevant experience.
Give full and accurate details of your relevant work experience with the most recent first.
Name and address of
Dates of employment
Nature of work and position held
organisation
From
To
H. Membership of professional bodies
Name and address of
organisation
Type of membership
Dates of membership
From
To
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I. Further information in support of application (Please attach additional sheet if necessary)
Taught Masters applicant – please provide a personal statement explaining why you have chosen this course, how your
previous education and experience have prepared you for the course and impact it will have on your future career.
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Research/PhD applicants – please provide an outline of your proposed research programme. This should include an outline
of the research questions/areas, aims of the project, methodology (if known), potential impact of the research and some key
background literature/references (1500 words).
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Research experience (list any publications) and other work relevant to your chosen programme of study.
J. References
Please give the names of two referees. At least one should be an academic member of staff at the institution where you
gained your most recent qualification.
Referee 1
Name
Referee 2
Name
Address
Address
Position
Position
Organisation/Institution
Organisation/Institution
Contact no.
Contact no.
Fax no.
Fax no.
E-mail address
E-mail address
K. Criminal Convictions
Do you have any criminal convictions (excluding motoring offences which a fine and/or penalty points were imposed)
Yes
No
If Yes, please state the type of criminal convictions:
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L. Please check that your application is complete and that you have enclosed all the relevant documents
Checklist:
Copy of Identity Card/Passport
First Degree Certificate
Masters Degree Certificate (where relevant)
Other Relevant Transcripts
English Language Qualification
Sponsorship / Scholarship Letter (if any)
Research Proposal (Research Masters/PhD)
Confidential report from Head of Department / Employer / Principal (for in-service training applicants only)
Other Supporting Document(s).Please specify:
M. Declaration
I declare that the information provided above is correct and I understand that the university will withdraw my
application if any aspect is found to have been falsified.
Applicant’s signature:
Date:
Application must be made in hard and soft copy.
1.
For hardcopy, please send/mail your completed application form with supporting documents in a sealed
envelope to the following:
Attention: Hajah Mariam Haji Abdul Rahman
The Staff and Student Centre
Universiti Teknologi Brunei
Lebuhraya Tungku
Gadong BE1410
BRUNEI DARUSSALAM
2. For softcopy, please email your completed application form with supporting documents to:
[email protected]
For further enquiries:
Tel: +6732461020-9 (10 lines)
Email: [email protected]
Website: www.utb.edu.bn
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