AiU Application Form
AiU Application Form
AiU Application Form
my
Photo
For International Applicants: i. ii. Foundation Studies } Undergraduate Programme } 30 May 2012
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
A. PERSONAL DETAILS Name as stated in the Identity Card/Passport (in capital letters): Gender: Male Female Citizenship: Date of Birth:
d d m m y y y y
Age:
Place of Issue:
Country/State of Origin:
Postcode
Country
Postcode
* please provide your own e-mail address and check your e-mail regularly for information on the application.
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
Citizenship:
Living Occupation:
Name of Mother:
Citizenship:
Living Occupation:
Name
Age
Relationship
Marital Status
Occupation
Income (US$/RM)
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
C. FINANCIAL BACKGROUND
Monthly Income of parents/ Guardian Father (RM/USD) Employment Business Rental Others Total
* Please submit a statement of income in the form of monthly salary slip, income tax statement or a letter from an authority stating the occupation of father/mother/guardian and the estimation of income per month.
Mother (RM/USD)
Guardian (RM/USD)
Family Expenditure Type of Expenditure House Installments/Rental Electricity/Water Telephone Loan Repayment (car/motor-bike/appliance) Transport Education Others (i.e. satellite television, internet etc) Monthly (RM/USD) Yearly (RM/USD)
Special Consideration Please highlight any problems with regards to income and expenditure that would allow us to give special consideration for your application and please provide supporting document for the statement (eg: high cost of medical treatment for family members): _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
Foundation Studies Application Form 2011
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
D.
EDUCATION INFORMATION. Highest Qualifications: Diploma/ Matriculation A-Level or equivalent O-level or equivalent
List of subjects and grade for the qualification: No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Subject Mathematics English Grade/ Marks Obtained
List of All Schools Attended and Qualifications/Diploma/Certificate Obtained* (Beginning from Primary Level) Type of Date of Date of Score/Grade/ Name/address of School Certificate Entry Exit CGPA/Division Obtained 1.
2.
3.
* Please submit certified copies of the original certificate and transcripts-documents need to be translated and certified in English
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
E. WORKING EXPERIENCE Name/address of Employer 1. Position Date of Entry Date of Exit
2.
F. EXTRA-CURRICULAR ACTIVITIES/COURSES ATTENDED** List your school/community/religious/sport/other activities/courses attended in the past three (3) years. Position held or honours From To Activities/Courses received (Month & Year) (Month & Year) 1. 2. 3. 4. 5.
** Please submit certified copies of the original certificates/documents
Community Participation Describe the nature of your involvement or associations within your community, including volunteer work and specify year of involvement and position held. (Although this award is based on financial need, information on community involvement will be considered) Association/Programme 1. 2. 3. G. ADDITIONAL INFORMATION i. Have you ever studied in any institution of higher learning in Malaysia or other institution overseas? Yes (If Yes, please fill in this Section) ii. Name and address of the institution(s): No, please proceed to Question iv. Position held or honours received From (Month & Year)
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
iii. Reasons for leaving: Study/Course completed If Others, please state: iv. Medical Disclosure Do you have any disability, impairment or long-term medical condition which may affect your studies? Yes No If you do, you need to specify or tick ( ) the relevant boxes. Dyslexia Asthma Hearing impairment Diabetic AIDS/HIV Require care support please specify .. Others please specify .. Epilepsy Wheelchair user/mobility difficulty Blind/ partially blind/colour blindness Tuberculosis Dismissed Withdrew Others
Yes
No
Name:
Address:
Relationship:
Contact no :
Vii. Where did you first learn about Albukhary International University and its programmes? (Please tick one box only) Advertisement Radio University Brochure Exhibition/Careers Fair Personal Recommendation World Wide Web Embassy/Consulate Office Other ____________________________
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
Other Funding/Assistance Do you receive or expect to receive any other funds during your period of study (This includes money from private trusts, charities, student loans access, hardship funds, etc.)? If YES, please provide the details: No. Name and address of Organisation Amount (RM/USD) Name: Address: 1. Contact: Name: Address: 2. Contact: F. Referees*: Name and contact details of two (2) people who can act as referees for this application (e.g. Embassy, Dean, Head of School, Head of Village/Community, Legal Practitioner) Name Address Position/Relationship (Mr/Ms) Email: Tel :
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
G.
Please write an essay (in English) of approximately 100 - 150 words, which will provide us with information about you that is not requested elsewhere in this application form. We are interested in learning about your educational goals and aspirations, your achievements and honours, your academic background, your special interests and experiences, your reasons for applying for the Albukhary scholarship and anything else that you would like us to know about you. ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ___________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ___________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ H. DECLARATION I hereby attest that I have personally filled in this Application Form and the information contained herein is complete and accurate to the best of my knowledge. I understand that withholding or giving false information will make me ineligible for admission and future enrolment. I further understand that I may be required to appear for an interview or to undergo such test as requested by the University as a condition for admission to the programme of study for which I have applied. Applicants Signature:
Foundation Studies Application Form 2011
Date: 9
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
CHECKLIST
Please submit all the following items along with the Application Form to ensure that your application is complete and can be processed for admission. Please tick ( ) in the appropriate boxes to indicate items that have been attached. a. Certified copies of National Identification/passport or any authorised identification. b. Certified copies of GCE O Level/A Level, SPM/STPM, or any other equivalent certificates. c. Certified copies of School Leaving Certificate/References. d. 2 Referees Recommendation Letter (in sealed envelope) e. 4 recent passport-size, colour photographs. f. 2 photos of your house (inside and outside)
g. Evidence of English Proficiency Examination (IELTS, TOEFL or equivalent) h. Financial Statement/Confirmation of parents income for the past three (3) months i. Certified copies of any other relevant documents i.e. Death Certificate of Parent(s), co-curriculum activities etc. Evidence of Other Funding/assistance
j.
Important: Please submit only certified photocopies of official documents. If the documents are not in English, certified English translation must be attached. Please note that all application forms will be disposed of six months after the closing date.
Upon completion, please return this form to: Registrar, Admissions and Records, Albukhary International University, Jalan Tun Abdul Razak, 05460 Alor Star, Kedah Darul Aman, MALAYSIA Tel: +604 - 7747300 Fax: +604 7747310 email: [email protected]
For Office Use Only: Date received: Country code:
Foundation Studies Application Form 2011
website: www.aiu.edu.my
Date of verification:
Reference no.
10
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
11
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
Referee statement
Thank you for providing this statement and your reference. They will help the Selection Committee during the selection process for the scholarships. The Referee information sheet provides information about the Albukhary Foundation, the scholarship and what is required for a reference. Please read it before completing this form and writing your reference.
Phone number
Applicant Circumstances Please use this section to highlight why you have recommended this applicant for the AIU Scholarship. Please tick one or more of the following criteria The nature of this referee statement is: academic reference OR community or personal reference OR professional reference I have known the applicant for: years
Attributes Attitude to school work - interest attitude desire to learn Dependability reliability, sense of duty, loyalty, sense of responsibility Initiative leadership, resourcefulness, self reliance, originality Character & personality standard of behaviour, integrity, self control, honesty, sincerity Presentation Impression made on others, maturity, manners, appearance, neatness Service to the community & voluntary involvement
Excellent
Good
Average
Poor
12
Application to AIU is free, if you are requested to pay in order to apply, please inform us at [email protected]
Additional Information Please use this section to provide any additional details of this applicants circumstances. You are also required to comments on the applicants financial background and why he/she deserved the Scholarship.
Recommend
Do not recommend
Referee Declaration* I confirm that the information given on this form is true, complete and accurate and no information or other material information has been omitted. Signature & Stamp Date
*IMPORTANT: The recommendation form is to be completed and STAMPED by the school/organization/village/community leader and NOT BY THE STUDENT OR FAMILY MEMBER. This reference should be included in a sealed separate envelope TOGETHER with the students completed application form.
Foundation Studies Application Form 2011
13