Universiti Tunku Abdul Rahman

Form Title : Application for Admission to Postgraduate Programme

Form Number: FM-IPSR-PSU-001 Rev No.: 11 Effective Date: 01/03/2018 Page No.: 1 of 14
Application for Admission Reference No.
(For office use only)
to Postgraduate
Programme UNIVERSITI TUNKU ABDUL RAHMAN DU012(A)
Wholly Owned by UTAR Education Foundation (Co. No. 578227 – M)

Complete ALL sections in BLOCK LETTERS and tick () appropriate boxes.
Affix a passport-
State the programme in which you wish to enrol [e.g. Master of Science, sized colour
Master of Arts (Chinese Studies); PhD(Engineering); etc]: photograph here
Please visit our webpage at http://ipsr.utar.edu.my/ for more information If you’re submitting
hardcopy of the
application form
Programme

Faculty

I. PERSONAL INFORMATION

1. Name (as in NRIC1/Passport2) : ________________________________________________________

2. (i) NRIC No.1: - - (1 For Malaysian applicant)

(2 For International applicant)
(ii) Passport No.2: Expiry Date: _______________

3. Nationality: ___________________________ 4. Date of Birth: ________/_________/_________

(Day / Month / Year)
5. Marital Status: Married Single 6. Gender: Male Female
(Please tick “ ” the appropriate box)

7. Correspondence Address

Address

Postcode State1 / Country2

Contact No.(Residence) Mobile No.
E-mail Address

8. Permanent Home Address (If different from the above Correspondence Address)

Address

Postcode State1 / Country2

Contact No.(Residence) Mobile No.
E-mail Address

9. (i) Race: ______________________________ (Only for Malaysian applicant)

(ii) Religion: Islam; Buddhism; Hinduism; Christianity; Others ______

10. Do you have any physical disability or illness? If “yes”, please specify the nature of this condition(s)
and enclose a photocopy of the medical report.
 Universiti Tunku Abdul Rahman
Form Title : Application for Admission to Postgraduate Programme
Form Number: FM-IPSR-PSU-001 Rev No.: 11 Effective Date: 01/03/2018 Page No.: 2 of 14

II. DETAILS OF CANDIDATURE

1. Mode of Study and Proposed Intake (Select ONE only)

(Please tick “ ” the appropriate box for your intended choice)

(A) By Research – Proposed Enrolment Date : _______________________ (mm/yyyy)

(Enrolment is open throughout the year. Processing time: 30 – 45 working days)

(B) Mixed Mode (C) By Coursework

Proposed Intake: January May October Year: _____________

2. Full-time Part-time (available to Malaysian students only)

3. Details of Proposed Research (For Postgraduate Programme by Research)

(Please visit http://www.utar.edu.my/ipsr/ for Research Areas of Academic Staff and suggested format of research proposal)

I. Proposed Research Area

II. Proposed Research Title

III. Proposed outline of research. (For Programme by Research, attach a detailed research proposal)
A research proposal (min. of 3 pages) should consist the following: 1. Introduction & Justification of the study (indicating
Research Background; Problem Statements & Objectives of the Research); 2. Literature Review; 3. Research
Methodology; 4. Proposed Work Schedule; 5. Expected Research Outcome; and 6. References

Note Applicant to discuss with the potential supervisor before submitting the agreed research proposal.
The proposed supervisor is required to endorse the agreed research proposal, by signing on every
page of the Research Proposal and to complete the prescribed FM-IPSR-PSU-036: Endorsement of
Research Proposal form. To find the potential Supervisor Please visit our webpage at
https://www.utar.edu.my/staffDirSearch.jsp for information on the Academic Staff and their Research
Areas)

4. Proposed Supervisor(s) (must be UTAR academic staff):

(i) Name: _________________________________________ Faculty: ______________________

(ii) Name: _________________________________________ Faculty: ______________________

 Universiti Tunku Abdul Rahman
Form Title : Application for Admission to Postgraduate Programme
Form Number: FM-IPSR-PSU-001 Rev No.: 11 Effective Date: 01/03/2018 Page No.: 3 of 14

III. ACADEMIC AND PROFESSIONAL QUALIFICATIONS

Undergraduate Qualifications

Dates Full-time Name of Degree Awarded Result Medium of

From - To or Institution CGPA/Grades/ Instruction
Part-time and Address/ Marks/Class of
Location Honours
Example
Universiti Tunku Bachelor of Business 3.7500 / 4.0000 English
Jan 2008 – Full-time Abdul Rahman, Administration (Hons) 1st Class Honours
Dec 2010 Perak, Malaysia

Postgraduate Qualifications (if any)

Dates Full-time Name of Degree Awarded Result Medium of

From - To or Institution CGPA/Grades/ Instruction
Part-time and Address/ Marks/Class of
Location Honours
Example
Universiti Tunku Abdul Master of Business 3.8500 / 4.0000 English
Jan 2011 – Full-time Rahman, Bdr Sg Long, Administration
Dec 2012 Malaysia

Professional Qualifications (if any)

Year Professional Body Examination/Exemption Stage/Level Medium of

Instruction
 Universiti Tunku Abdul Rahman
Form Title : Application for Admission to Postgraduate Programme
Form Number: FM-IPSR-PSU-001 Rev No.: 11 Effective Date: 01/03/2018 Page No.: 4 of 14

List Titles of Publications, Major Papers, or Thesis of which you are author or co-author.
(Continue on a separate sheet if necessary)

List Scholarships and/or Prizes received (if any)

Name of Scholarship/ Reason for Award Date of Award Value of

Prizes Scholarship

IV. LANGUAGE PROFICIENCY

Please visit IPSR webpage in UTAR website for Details of Language Requirement)

If you are applying for Master’s or PhD programme where If you are applying for Master’s or PhD programme
the medium of instruction is English language: where the medium of instruction is Chinese language:

Result of English Language Proficiency Test taken Result of Chinese Language Proficiency Test
English Your Date Taken taken
Proficiency Test Grade/Score/ (mm/yyyy) Chinese Your Date Taken
Band Proficiency Test Grade/Score/ (mm/yyyy)
Band
TOEFL
SPM / O-level
IELTS Chinese Language
UEC Chinese
CPE
Language
CAE STPM Chinese
Language
PTE
Chinese
O-level English Proficiency Test:
Language HSK (The
MUET Intermediate
Certificate)
Others (Please
specify) Test of Proficiency
- Huayu: TOP
(Advanced level)
Others (Please
specify)
 Universiti Tunku Abdul Rahman
Form Title : Application for Admission to Postgraduate Programme
Form Number: FM-IPSR-PSU-001 Rev No.: 11 Effective Date: 01/03/2018 Page No.: 5 of 14

V. WORKING EXPERIENCE (3 most recent)

From To Name and Address of Employer Nature of Work and

(mm/yyyy) (mm/yyyy) Position Held

VI. STUDY PURSUED AT SIMILAR LEVEL

(Please tick “ ” appropriate box)
Had you pursued study at similar level (as the programme you are applying now) at other Institutions of
Higher Learning? Yes No
If “Yes”, please provide details in the table below :

Name of Institution of Higher Learning

Level Master’s PhD / Doctoral Status of study

Area of study

VII. FINANCIAL SUPPORT

Tick “ ” your means of financial support. Enclose a photocopy of supporting document(s), if any.

Self-support / Scholarship / External Bank Others (Please specify):

Family Sponsorship Loan

If pursue study under scholarship/sponsorship:

Name of Scholarship/ Sponsor
Address
Contact No.(Office) Mobile No.
Note For Malaysian applicant, attach letter of sponsorship from sponsoring organization;
For International applicant, attach letter of sponsorship from sponsoring organization

VIII. IMMIGRATION VISA (For international applicant only)

(Please tick “ ” the appropriate box)

1. Holding any type of Malaysian VISA now? Yes No

2. If “Yes”, the type of VISA: Social visit Student Diplomatic Dependent

VISA No. : _____________________________ Expiry date: ___________________

3. If you are currently or were formerly a student of another University/College/Institute in Malaysia:

Name of the University/College/Institute

Programme/Course

Date of Joining

Date of Leaving

Reason for Leaving the Programme/Course

 Universiti Tunku Abdul Rahman
Form Title : Application for Admission to Postgraduate Programme
Form Number: FM-IPSR-PSU-001 Rev No.: 11 Effective Date: 01/03/2018 Page No.: 6 of 14

IX. ACCOMMODATION (For international applicant only)

______________________________________

Do you require assistance in arranging for accommodation? Yes No

X. REFEREES
Note: (1) Potential supervisor cannot be the referee; (2) If possible, both referees be from the academic line (If not, minimum one)

First Referee Second Referee

Title

Name

Occupation

Address

Contact No.

Mobile No.

E-mail Address

Fax No.
Note Also complete the prescribed Referee Form as attached below – 1 set for each referee. The completed
referee forms in individual sealed envelopes must be submitted together with this application form.

XI. PURSUE STUDY AT OTHER INSTITUTIONS

UTAR requires candidate, who upon admission into UTAR Master’s or Doctor of Philosophy degree
programme, not to pursue other postgraduate degree programme in the same discipline in UTAR or any
other Institutions of Higher Learning. Prior written approval must be obtained from UTAR if the candidate
intends to pursue other academic programme in UTAR or any other Institutions of Higher Learning during
the period of his candidature.

XII. DECLARATION BY APPLICANT

I hereby declare that
(i) it is my responsibility to find and understand all information on the programme before submitting this
application for admission to Universiti Tunku Abdul Rahman for consideration;
(ii) the information provided by me in connection with this application is true and correct. I understand
that Universiti Tunku Abdul Rahman reserves the right to withdraw the offer of admission and/or ask
me to leave the University, if at any time, such information is found to be false or incorrect or I failed to
abide by the requirement as stated in Section XI above.
(iii) I understand and agree to the University using and processing my personal data as contained in this
form. I have read, understood and agreed to the Personal Data Protection Statement of the University
as stated in Section XIII. [You may access and update your personal data by writing to IPSR Director
at [email protected]]

____________________________ _________________________ _______________

Name of Applicant Signature of Applicant Date
 Universiti Tunku Abdul Rahman
Form Title : Application for Admission to Postgraduate Programme
Form Number: FM-IPSR-PSU-001 Rev No.: 11 Effective Date: 01/03/2018 Page No.: 7 of 14

XIII. PERSONAL DATA PROTECTION STATEMENT

Please be informed that in accordance with Personal Data Protection Act 2010 (“PDPA”), Universiti Tunku
Abdul Rahman (“UTAR”) is hereby bound to make notice and require consent in relation to collection,
recording, storage, usage and retention of personal information.

Notice:
1. The purposes for which your personal data may be used are inclusive but not limited to:-
 For assessment of any application to UTAR
 For processing any benefits and services
 For communication purposes
 For advertorial and news
 For general administration and record purposes
 For enhancing the value of education
 For educational and related purposes consequential to UTAR
 For the purpose of our corporate governance
 For consideration as a guarantor for UTAR staff/ student applying for his/her scholarship/ study
loan
2. Your personal data may be transferred and/or disclosed to third party and/or UTAR collaborative
partners including but not limited to the respective and appointed outsourcing agents for purpose of
fulfilling our obligations to you in respect of the purposes and all such other purposes that are related
to the purposes and also in providing integrated services, maintaining and storing records. Your data
may be shared when required by laws and when disclosure is necessary to comply with applicable
laws.
3. Any personal information retained by UTAR shall be destroyed and/or deleted in accordance with our
retention policy applicable for us in the event such information is no longer required.
4. UTAR is committed in ensuring the confidentiality, protection, security and accuracy of your personal
information made available to us and it has been our ongoing strict policy to ensure that your personal
information is accurate, complete, not misleading and updated.

Consent:
1. By submitting this form you hereby authorise and consent to us processing (including disclosing) your
personal data and any updates of your information, for the purposes and/or for any other purposes
related to the purpose.
2. If you do not consent or subsequently withdraw your consent to the processing and disclosure of your
personal data, UTAR will not be able to fulfill our obligations or to contact you or to assist you in
respect of the purposes and/or for any other purposes related to the purpose.
3. You may access and update your personal data by writing to us at [email protected].
 Universiti Tunku Abdul Rahman
Form Title : Application for Admission to Postgraduate Programme
Form Number: FM-IPSR-PSU-001 Rev No.: 11 Effective Date: 01/03/2018 Page No.: 8 of 14

XIV. APPLICATION INSTRUCTIONS AND CHECKLIST

Remember to:
 Complete all relevant sections of the form, then sign and date the declaration on the form
 Submit completed application form together with the following documents:
For Malaysian Applicant
Item to be submitted If submitting If submitting
hardcopy of application via on-
application form line
(i) Certified true copy of Identity Card (front and back) Submit certified Submit scanned
true copies of (i) – copies of (i) – (v) as
(ii) Certified true copy of the full official transcript of your
(v) together with email attachments to
academic record and certificates for all studies at the
application form [email protected]
undergraduate level, postgraduate level (if any), or
other equivalent qualifications. Transcripts must
show all subjects taken including failures, marks,
and/or grades awarded with an explanation of the
grading system
(iii) Certified true copy of MCE / SPM certificate
(iv) Certified true copy of the English Language
Proficiency Test results (if any)
(v) Certified true copy of membership of professional
bodies (If applicable)
(vi) A non-refundable application/processing fee of Pay by Money/ Pay into UTAR
RM60 Postal Order/ Bank account with Public
Draft/Banker’s Bank (Details of the
UTAR Bank Account with Public Bank
Cheque or Personal bank account is
Name of Beneficially : Universiti Tunku Abdul Rahman
Cheque (where indicated in the left
Account No. : 3118325015 drawee bank is in column).
Name of Bank : Bandar Sungai Long Branch Malaysia) payable to
1 & 3, Jalan SL 1/11, Bandar Sungai Long, Note
Universiti Tunku
43000 Kajang, Selangor Darul Ehsan, Fax proof of payment
Malaysia
Abdul Rahman
(bank-in slip) to Fax No.
MalaysiaSwift Code : PBBEMYKL 03-90197880 or scan
proof of payment and
Note Payment by cash or by Public Bank credit card or email to
Public Bank debit card can be made at Division of [email protected]
Finance counter in any UTAR campus

(vii) 1 passport-sized colour photographs affixed on the Submit together Send 1 colour
front page of this form with application photographs to IPSR
form (hand-deliver or post
or by courier service)
(viii) Referee Forms from two referees Submit in individual Send in individual
sealed and signed sealed and signed
envelopes together envelopes to IPSR
with application (hand-deliver or post
form or by courier service)
(ix) Letter of scholarship/sponsorship, etc (If applicable) Submit together Email scanned copy
with application as attachment or
form hand-deliver or by
post or by courier
service to IPSR
Note (a) If you’re submitting the application/documents by post or by courier service, please forward to
Institute of Postgraduate Studies and Research (IPSR) at the address stated in Section XV.
(b) Receipt of the above items (i) – (vi) by IPSR is required for immediate processing of your
application
 Universiti Tunku Abdul Rahman
Form Title : Application for Admission to Postgraduate Programme
Form Number: FM-IPSR-PSU-001 Rev No.: 11 Effective Date: 01/03/2018 Page No.: 9 of 14

For International Applicant

Item to be submitted If submitting If submitting
hardcopy of application via on-
application form line
(i) 3 sets of certified true copy of your passport (all Submit certified Submit scanned
pages of the passport including blank pages) true copies of (i) – copies of (i) – (iv) as
(iv) together with email attachments to
(ii) Certified true copy of the full official transcript of your
application form [email protected]
academic record and certificates for all studies at the
undergraduate level, postgraduate level (if any), or
other equivalent qualifications. Transcripts must show
all subjects taken including failures, marks, and/or
grades awarded with an explanation of the grading
system
(iii) Certified true copy of the English Language
Proficiency Test results (if any)
(iv) Certified true copy of membership of professional
bodies (If applicable)
(v) A non-refundable processing fee of RM300/USD100 Pay by Bank Draft/ Via Telegraphic
Banker’s Cheque Transfer to UTAR
UTAR Bank Account with Public Bank
(issued by a bank bank account (Details
Name of Beneficially : Universiti Tunku Abdul Rahman
in Malaysia) which of the bank account is
Account No. : 3118325015 is made payable to indicated in the left
Name of Bank : Public Bank Berhad Universiti Tunku column).
Bandar Sungai Long Branch Abdul Rahman.
No.1 & 3, Jalan Sungai Long 1/11 Note
Bandar Sungai Long Note Please fax proof of
43000 Kajang Submit the above payment ( bank advice/
Selangor Darul Ehsan, Malaysia payment together transaction receipt) to
Swift Code : PBBEMYKL Fax No. 03-90197880,
with application
form or email scanned copy
Note Payment by cash or by Public Bank credit card or of proof of payment to
Public Bank debit card can be made at Division of [email protected]
Finance counter in any UTAR campus
(vi) 6 passport-sized colour photographs (excluding the Submit together Send 7 colour
one affixed on the front page of this form) with application photographs to IPSR
form (hand-deliver or post
or by courier service)
(vii) Referee Forms from two referees Submit in individual Send in individual
sealed and signed sealed and signed
envelopes together envelopes to IPSR
with application (hand-deliver or post
form or by courier service)
(viii) Bank statement of the past 6 months Submit together Email scanned copies
with application as attachments or
(ix) Letter of scholarship/sponsorship, etc (If applicable)
form hand-deliver or by
(x) Institution Leaving Certificate/Testimonial, Release post or by courier
Letter, Results, Academic transcript and Attendance service to IPSR
report (Applicable to International applicant
transferring from another University/College/Institute
in Malaysia and holding a Student Pass or Dependent
Pass)
(xi) NOC (No Objection Certificate) for applicant from Sub
Saharan African countries While LOE( Letter of
Eligibility) for applicant from Federal Republic of
Nigeria and Republic of Iran

Note (a) If you’re submitting the application/documents by post or by courier service, please forward to
Institute of Postgraduate Studies and Research (IPSR) at the address stated in Section XV.
(b) Receipt of the above items (i) – (v) by IPSR is required for immediate processing of your
application

XV. SUBMISSION OF APPLICATION FORM & SUPPORTING DOCUMENTS

 Universiti Tunku Abdul Rahman
Form Title : Application for Admission to Postgraduate Programme
Form Number: FM-IPSR-PSU-001 Rev No.: 11 Effective Date: 01/03/2018 Page No.: 10 of 14

Send the completed application form and all supporting documents and items stated above to:
Institute of Postgraduate Studies and Research (IPSR)
Universiti Tunku Abdul Rahman,
PO Box 11384,
50744 Kuala Lumpur, Malaysia
or
Institute of Postgraduate Studies and Research (IPSR)
Universiti Tunku Abdul Rahman,
Jalan Sungai Long,
Bandar Sungai Long,
Cheras, 43000 Kajang,
Selangor, Malaysia
or
Institute of Postgraduate Studies and Research (IPSR)
Universiti Tunku Abdul Rahman,
Jalan Universiti,
Bandar Barat,
31900 Kampar,
Perak Darul Ridzuan, Malaysia

How did you first learn about UTAR and its programmes?

Advertisement (Please specify) ___________________________________________

World Wide Web Brochures Poster Education Fair/Exhibition/Seminar

Personal Recommendation e.g. Friends/Relatives/Family Members

Others (Please Specify) _________________________________________________

 Universiti Tunku Abdul Rahman
Form Title : Referee Form for Postgraduate Study
Form Number: FM-IPSR-PSU-002 Rev No.: 4 Effective Date: 12/01/2016 Page No.: 1 of 2

Referee Form for

Postgraduate Study TUNKU ABDUL RAHMAN DU012(A)
UNIVERSITI
Wholly Owned by UTAR Education Foundation (Co. No. 578227 – M)

Part 1 of this form should be completed by the applicant and handed to the referee to complete Part 2.
Referees are to return it in a signed sealed envelope to the applicant to attach with the application form.

Part 1: To be completed by the Applicant

Name (as in NRIC/Passport): ____________________________________________________________

Address: ____________________________________________________________________________

____________________________________________________________________________________

Programme Applied For ________________________________________________________________

Proposed Date of Admission: ____________________________________________________________

Name of Referee: ________________________________________________________________

Part 2: To be completed by the Referee

The above named applicant is applying for graduate study at Universiti Tunku Abdul Rahman and has
named you as a referee. We should be grateful if you could provide us with a reference on the applicant’s
academic and/or general suitability to undertake the proposed programme of study by completing Part 2
of this form or by attaching a letter of reference on letter-headed paper.

In particular, it would be of great assistance if you could comment on the applicant’s previous academic
achievement, as well as any strengths and weaknesses (e.g. determination, diligence, motivation, ability
to work independently, ability to work under sustained pressure, emotional maturity, and initiative). In
addition, we would appreciate your opinion on the applicant’s standard of proficiency in written and oral
English.

Thank you for your assistance. Please be assured that your reply will be treated in strictest confidence by
the University. Please return this form to the applicant in an envelope with your signature across the seal
to ensure confidentiality.

Name of Referee: ____________________________________________________________________

Designation: ________________________________________________________________________

Address: ___________________________________________________________________________

___________________________________________________________________________________

Postcode: _____________________________ State: _____________________________

Contact No: ____________________________ Fax No: ___________________________

E-mail Address: _____________________________________________________________________

 Universiti Tunku Abdul Rahman
Form Title : Referee Form for Postgraduate Study
Form Number: FM-IPSR-PSU-002 Rev No.: 4 Effective Date: 12/01/2016 Page No.: 2 of 2

How long have you known the applicant and in what capacity?

Number of Years: ________________________

In my capacity as: Lecturer/Professor/Academic Advisor/Research Advisor

Employer

Others _____________________________________________________
(Please specify)

Comments:

Referee’s Declaration
(i) I confirm that, to the best of my knowledge, the information given in this form is correct and complete.
(ii) I understand and agree to the University using and processing my personal data as contained in this
form. I have read, understood and agreed to the Personal Data Protection Statement of the University
(Please visit https://www.utar.edu.my/PrivacyNotice_English.jsp to view our Privacy Notice). [If you
wish to make any inquiries, correction, complaints or access to your personal data, please contact
IPSR Director at [email protected]]

Signature: _____________________________________ Date: ________________________

Official Stamp:
 Universiti Tunku Abdul Rahman
Form Title : Referee Form for Postgraduate Study
Form Number: FM-IPSR-PSU-002 Rev No.: 4 Effective Date: 12/01/2016 Page No.: 1 of 2

Referee Form for

UNIVERSITI
Postgraduate Study TUNKU ABDUL RAHMAN DU012(A)
Wholly Owned by UTAR Education Foundation (Co. No. 578227 – M)

Part 1 of this form should be completed by the applicant and handed to the referee to complete Part 2.
Referees are to return it in a signed sealed envelope to the applicant to attach with the application form.

Part 1: To be completed by the Applicant

Name (as in NRIC/Passport): ____________________________________________________________

Address: ____________________________________________________________________________

____________________________________________________________________________________

Programme Applied For ________________________________________________________________

Proposed Date of Admission: ____________________________________________________________

Name of Referee: ________________________________________________________________

Part 2: To be completed by the Referee

The above named applicant is applying for graduate study at Universiti Tunku Abdul Rahman and has
named you as a referee. We should be grateful if you could provide us with a reference on the applicant’s
academic and/or general suitability to undertake the proposed programme of study by completing Part 2
of this form or by attaching a letter of reference on letter-headed paper.

In particular, it would be of great assistance if you could comment on the applicant’s previous academic
achievement, as well as any strengths and weaknesses (e.g. determination, diligence, motivation, ability
to work independently, ability to work under sustained pressure, emotional maturity, and initiative). In
addition, we would appreciate your opinion on the applicant’s standard of proficiency in written and oral
English.

Thank you for your assistance. Please be assured that your reply will be treated in strictest confidence by
the University. Please return this form to the applicant in an envelope with your signature across the seal
to ensure confidentiality.

Name of Referee: ____________________________________________________________________

Designation: ________________________________________________________________________

Address: ___________________________________________________________________________

___________________________________________________________________________________

Postcode: _____________________________ State: _____________________________

Contact No: ____________________________ Fax No: ___________________________

E-mail Address: ____________________________________________________________________

 Universiti Tunku Abdul Rahman
Form Title : Referee Form for Postgraduate Study
Form Number: FM-IPSR-PSU-002 Rev No.: 4 Effective Date: 12/01/2016 Page No.: 2 of 2

How long have you known the applicant and in what capacity?

Number of Years: ________________________

In my capacity as: Lecturer/Professor/Academic Advisor/Research Advisor

Employer

Others _____________________________________________________
(Please specify)

Comments:

Referee’s Declaration
(i) I confirm that, to the best of my knowledge, the information given in this form is correct and complete.
(ii) I understand and agree to the University using and processing my personal data as contained in this
form. I have read, understood and agreed to the Personal Data Protection Statement of the University
(Please visit https://www.utar.edu.my/PrivacyNotice_English.jsp to view our Privacy Notice). [If you
wish to make any inquiries, correction, complaints or access to your personal data, please contact
IPSR Director at [email protected]]

Signature: _____________________________________ Date: ________________________

Official Stamp:
 Universiti Tunku Abdul Rahman
Form Title : Endorsement of Research Proposal
Form Number: FM-IPSR-PSU-036 Rev No.: 1 Effective Date: 07/10/2019 Page No.: 1 of 1

Note: This form is to be completed by the proposed Main Supervisor and to be submitted
along with the Research Proposal. The proposed Main Supervisor should sign on every
page of the research proposal.

Applicant Name:
Section A: Proposed Supervisor Details
Main Supervisor
Name :
Co-Supervisor
Name 1 :
Co-Supervisor
Name 2 :
Justification for proposing more than one Co-Supervisors (if any)

Section B: Research Proposal Details

Research Area:

Research Title:

Research Centre
Is the Research Area /Title related to the Faculty? Yes/ No
Will this research be funded by any Research Grant? Yes/ No
(If Yes, please stated below the Project No and Funding Body. If No, state how
will the project be supported )

Section C: Endorsement by Propose Supervisor

I have read through the research proposal and it’s adequate for application into Master /
PhD Degree

Main Supervisor Signature: Date:

Co-Supervisor Signature: Date:

Co-Supervisor Signature: Date: