Updated 24072013

REGISTRATION NO: (For University use)

Application Reference No
(For University use)




Code

Accepted

Conditional

Pending

Rejected
Credits
Accumulated
Modules
required
University
use only


Application Form
Heriot-Watt University Malaysia

PLEASE USE CAPITAL LETTERS ONLY

Section A PERSONAL PARTICULARS



Proposed Programme

Course Title

Start Date (please check available dates) MM/YY

Method of study (please check whether a part-time option is available for your chosen course) Full-time Part-time


PERSONAL DETAILS

Title (Dr / Mr / Miss / Mrs / Ms / Other)
First Name(s)



Surname/Family Name/Last Name


Date of Birth (DD/MM/YYYY)



Sex (Male / Female)



Please affix a
current colour
passport
photograph. This
must be on a blue
background.


Permanent Address Correspondence Address (if different)




Residence Tel No: Residence Tel No:
Office Tel No: Office Tel No:
Mobile No: Mobile No:
Fax No: Fax No:
Email Address: Email Address:

Updated 24072013

Nationality Country of Birth Country of Permanent
Residence
Race Religion


NRIC / Passport No. Date of Issue (DD/MM/YYYY)


Date of Expiry (DD/MM/YYYY)



VISA DETAILS

Do you hold any immigration pass now? No Yes (please provide details below)

Visa No. Visa Type

Date of Issue (DD/MM/YYYY) Date of Expiry (DD/MM/YYYY)


LEVEL OF ATTAINMENT IN ENGLISH
If English is not your first language, please specify in the space below the standard you have attained. (eg GCSE or
TOEFL or IELTS)
Formal Qualifications
(GCSE or TOEFL or IELTS)
Grade Date (MM/YY) Other experience of using the English Language
(Please give details)



EMERGENCY CONTACT









SPECIAL ARRANGEMENT
Do you have any disability or impairment that may affect your studies? YES NO
We want to know about any disability or impairment so that we can make sure that we can provide you with any additional support that you might need
during your period of study with Heriot-Watt University Malaysia.

ACCOMODATION
Do you need accommodation placement? YES NO

CRIMINAL CONVICTION
Do you have a relevant criminal conviction? YES NO
To help the universities reduce the risk of harm or injury to their students caused by the criminal behavior of other students, they must know about any
relevant criminal convictions that you have. Relevant criminal convictions are only those convictions for offences against the person, whether of a violent or
sexual nature, and convictions for offences involving unlawfully supplying controlled drugs and substances where the conviction concerns commercial drug
dealing or trafficking.











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Section B EDUCATION BACKGROUND


PREVIOUS ACADEMIC & PROFESSIONAL INFORMATION
Please give details of all Degrees / Diplomas / Other Qualifications
Name of University /
College / Institution
From To Title of
Qualification
Class of
Degree
Date Awarded Date to be
Awarded






EMPLOYMENT HISTORY (If applicable)

Please enter present and any previous employment starting with the most recent. Please continue on a
separate sheet if necessary.

Employer Nature of Work/ Key responsibilities From
Month Year

To
Month Year














For courses that require work experience, please enclose relevant documents for proof of employment. E.g. Letter
from human resource department, letter from employer, offer letter, or any other document, which is able to verify
your employment history.

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SECTION D - DECLARATION

SECTION C - TERMS AND CONDITIONS OF ENROLMENT
Students are advised to read the policies and terms and conditions governing the admission to Heriot-Watt University Malaysia as set out below.
Admission to Heriot-Watt University Malaysia is open to all individuals regardless of gender, race, religion, or nationality. Selection of admission is
based on an overall assessment of the individuals potential. The university reserves the right to reject an application and to review a students
progress periodically. The university may at its discretion, cancel a student registration for lack of academic progress, failure to honour fees payable
or failure to abide by the Rules and Regulations of Heriot-Watt University Malaysia.
Fees payable for the academic year are as set out in the Fees Schedule. Please note that fees are normally reviewed on an annual basis and that
the fees indicated on the current fees schedule may not be the fees applicable for subsequent semesters/terms. For the avoidance of doubt, Heriot-
Watt University Malaysia has the right to revise the fee payable.
All fees are payable in advance. Full settlement of first semester fee is required upon registration or by the intake date and according to the due
dates for subsequent semesters as stated in the payment schedule.
Payment of fees may be made by crossed cheque, telegraph transfer or bank draft in favour of HERIOT-WATT UNIVERSITY MALAYSIA SDN BHD
Fees paid are not transferable and not refundable except in the circumstances set out below and provided that a request in writing for such refund is
received. Any refund of fees or part thereof is subject to the following:
a. The Registration Fee, International Student Application fee, International Student Annual Fee, and Education Malaysia Global Services
(EMGS) application fee are not refundable under any circumstances.
b. Subject to sub paragraph (a), if a student provides notice more than 2 weeks before the commencement of the semester, 100% of the
tuition fees paid may be refundable.
c. Subject to sub paragraph (a), if a student provides notice within 2 weeks before the commencement of the semester, 50% of the tuition
fees paid may be refundable.
d. Subject to sub paragraph (a), if a student provides notice within 2 weeks after the commencement of the semester, 50% of the tuition
fees paid may be refundable.
e. No fees are refundable 2 weeks after the commencement of the semester.
f. Subject to sub paragraph (a) above, if a student is required to leave the programme due to medical reasons based on medical evidence,,
the student will be eligible for a full refund of all fees paid.
All refund whether of fees, deposits or whatsoever payments, shall be free of interest and shall be subject to the right of set-off by Heriot-Watt
University Malaysia against any fees or whatsoever payments due and owing to Heriot-Watt University Malaysia.
For all semesters, all fees are payable in advance and must be fully paid before or by the start date of the semester. An administrative charge of
RM100 per week will be imposed commencing from the third week of the semester if payment in full is not received by the due date of each week or
part thereof delayed. Heriot-Watt University Malaysia reserves the right to review the status and to take such necessary action as Heriot-Watt
University Malaysia deems fit if payment is not received by the end of the fourth week of the semester. Such action may include the barring of the
student from classes, examinations and facilities, suspension or termination of the student. In such circumstances, Heriot-Watt University Malaysia
further reserves the right and shall be entitled to defer the marking of any examination paper, and to withhold all certificates and records of the
student. No student with outstanding debt shall be permitted to graduate.
In the event that a student is expelled or is suspended or discontinues the programme due to misconduct or any disciplinary matter or the non-
attainment of academic requirement, there shall be no refund of fees paid.
Students must abide by all academic, administrative and examination rules, regulations and policies of Heriot-Watt University Malaysia in force and
to be enacted in future. Students are hereby advised that the rules and regulations governing the student whilst the student is enrolled as a student
of Heriot-Watt University Malaysia may be viewed at Heriot-Watt University Malaysia website (www.hw.edu.my) and is available for reading at the
library. On admission as a student of Heriot-Watt University Malaysia, the student is bound by such rules and regulations regardless whether the
student has acquainted himself/herself of such rules and regulations. Heriot-Watt University Malaysia reserves the right at anytime to elect new rules
and regulations and to amend such rules and regulations to take effect immediately, and students are further advised to refer to Heriot-Watt
University Website or at the library regularly for such amendments.
In the interest of the student and/or other students of Heriot-Watt University Malaysia, the Head of School may at his or her discretion prohibit a
student from attending classes or at the University for such period as the Head of School deems necessary in the event of the student having a
contagious or infectious disease or illness or in the event of an outbreak of an contagious or infectious disease or illness at Heriot-Watt University
Malaysia regardless whether the student is so infected or otherwise. No claim may be brought against Heriot-Watt University Malaysia (whether for a
refund of fees or part thereof or otherwise whatsoever) arising from any such action taken.
The award of scholarships, bursaries, grants, waivers, or financial assistance is subject to the absolute discretion of Heriot-Watt University Malaysia.



Signature of student: _______________________________________________ Date _________________

Full name as per NRIC/Passport:




















































Updated 24072013


INTRODUCTION DETAILS
What was the main source of information, which led you to find out more about study at Heriot-Watt
University Malaysia?
Please tick one box only.
Your Teachers / School Counselor Search Engine (Google / Yahoo)
Careers Service www.hw.ac.uk
Friends or Family www.hw.edu.my
Current Heriot-Watt student or alumnus Education Guide Book
Education fair or school fair Advertisement
Recruitment agent Employer/HR department
Word of mouth Professional Association
Open day on campus Others. Please state:____________________________



Are you a member of staff at Heriot-Watt University Malaysia? YES NO
Are you a spouse / child of a member of staff at Heriot-Watt University Malaysia? YES NO
If the answer to the above is yes, state the name of the staff member

DECLARATION: (To be signed by the applicant)

1 I confirm that to the best of my knowledge the information given in this form is correct. I understand that any
misrepresentation of information may result in Heriot-Watt University Malaysia revoking acceptance or
terminating my enrolment.
2 I undertake that I will comply with all policies, rules and regulations of Heriot-Watt University Malaysia including
those of respective departments.
3 I accept liability for payment of tuition fees in the absence of an awarding body and failure to pay any
outstanding fees by the due date may lead to cancellation of my enrolment.
4 Heriot-Watt University Malaysia will use all reasonable endeavors to deliver courses and programmes of study
as communicated to the students, and at the fee payment structures and fee levels published. It is possible,
however, that some changes may occur and the University reserves the right to make variations to the content
or method of delivery of courses, to discontinue or combine courses, to introduce new courses or to adjust fee
payment structures or fee levels if at any time such action is considered to be reasonable and necessary.
5 I consent to the processing by the University of personal data (including sensitive personal data as defined in
the Data Protection Act 2010 (when applicable) about me for the proper purposes of the institution.
6 I consent to share my data among Heriot-Watt University Malaysia, Heriot-Watt University and other
subsidiaries for the purposes of programme administration.
7 I confirm that I have read and understood the terms and conditions governing the fee payment structures and
fee levels for courses and programmes. I hereby apply for enrolment and if accepted, I agree to comply with
the standard rules, regulations and ordinances of Heriot-Watt University generally and Heriot-Watt University
Malaysia specifically. If I do not comply with any of the rules of the University, the University has the right to
take disciplinary action against me.






Signature Date

Full name as per NRIC/Passport:








Updated 24072013




CHECKLIST: For Malaysian students or those who do not require a student visa to study in Malaysia


Completed application form


Proof of English language proficiency (if applicable)


Originals or certified copies of academic transcripts, grading systems including certified translation if not in English


Proof of employment (if applicable)

A letter from applicants employer confirming length of service, and job title. These should be provided on original company

letterhead, addressed to Heriot-Watt University Malaysia and be signed and dated by employer.


Certified copy of NRIC


Two (2) passport sized colour photographs


Registration fee of RM 500 payable to below bank account


CHECKLIST: For Students requiring the Universitys visa sponsorship i.e.
Students from outside of Malaysia who require a student visa to study in Malaysia


Completed application form

Personal bond payable to the university (Amount may vary between countries. Please check with admission)

Originals or certified copies of academic transcripts, grading systems including certified translation if not in English

Proof of employment (if applicable)

Proof of English language proficiency (if applicable)

Certified copies of passport (Every page include empty pages) (Valid at least 12 months before entry date)

Two (2) passport sized colour photographs (with BLUE background)

No Objection Certificate / Eligibility Letter (Only for student from Africa & Sub Saharian countries)

International Student Charge RM 2650 (EMGS, Insurance, Medical Screening, Student visa/pass and administration fee)



MODE OF PAYMENT:

1) Bank draft / cheque / postal orders payable to below bank details
2) Direct bank-in to below bank details
3) Cash is only acceptable at Admission Office only

BANK DETAILS:
Payable to : HERIOT-WATT UNIVERSITY MALAYSIA SDN BHD
Account No : 5140-1102-2817
Bank Name : Malayan Banking Berhad (Maybank)
Bank Address : Floor 8, Menara Maybank, 100 Jalan Tun Perak, 50050 Kuala Lumpur, Malaysia
Swift Code : MBBEMYKL
FOR UNIVERSITY USE:


Updated 24072013
CONDITIONS TO BE MET BY STUDENT BEFORE ENTRY (please tick as appropriate)


Need for Completion of present course. State minimum award for entry.

Proof of English ability

Evidence of previous academic attainment

Need for further references. Please specify from whom.

Any others. (Please provide detail)









RECOMMENDATION (please tick as appropriate)

I recommend that the application be

Accepted

Accepted on the conditions specified above

Not accepted

Head of School or Authorized Signatory




Signature Date __________________________



CONSULTANT SIGNATURE AGENTS VERIFICATION (if applicable)






Name:
Date: (Company Stamp / Sticker)

Please return this form to:

Admissions Office
Heriot-Watt University Malaysia
Level 2, Menara PjH,
No.2 Jalan Tun Abdul Razak,
Precinct 2, 62100 Wilayah
Persekutuan Putrajaya

Tel: +603 8881 0918
Fax: +603 8881 0194

Email: [email protected]
Website: www.hw.edu.my