APPLICATION FORM Student Number:

For office use only

(Masters, DBA & PhD only)

 Malaysian Programme Code:

 International
Country
Please complete and return this form to:
Asia Pacific University of Technology & Innovation (APU)
Technology Park Malaysia, Bukit Jalil, 57000 Kuala Lumpur, Malaysia.
Tel: 603-8996 1000 Email: [email protected]

PART A: PERSONAL DETAILS

Title: Mr Ms Mrs Others Gender: Male Female

Name (as per IC / Passport): Race:

IC Number (For Malaysian Students only): Religion:

Passport Number (For International Students only): Nationality: Marital Status:

Date of Birth (dd/mm/yyyy): Place of Birth:

Student’s Correspondence Address:

Postcode: City / State: Country:

Contact Number: Email ( please write clearly):

Tel Mobile

Parent / Guardian Name: Parent / Guardian Contact Number:

Tel Mobile

Parent / Guardian Permanent Address (If different from Student’s Correspondence Address):

Postcode: Country: Parent / Guardian Email ( please write clearly):

Contact Person in Case of Emergency: Relationship to the Student:

Contact Number: Email ( please write clearly):

Tel Mobile

PART B: PROGRAMME APPLIED FOR

Level of Study: Mode of Study:
Masters Degree DBA PhD Full-time Part-time ODL - 100% Online
Programme Name:

Intake Date (mm/yy):

PART C: ACADEMIC BACKGROUND (from highest to lowest)
Please give details of the last TWO (2) universities/ colleges you attended (most recent first)
Please attach copies of your certificates and the transcripts of all results obtained for your highest level of study, plus a certified translation if the orginals are not in
English.
Programme Year Major/ Class/ Language of
Name of Programme Name of Institution & Country
Length Awarded Discipline CGPA Instruction

PART D: CAREER HISTORY/ VOLUNTARY WORK/ RELEVANT EXPERIENCE

Please give details of your last TWO (2) situations relating to employment, training and/ or professional experience (most recent first)
Position held & main Full-time/ Period of Employment
Name of Employers & Address Reason for Leaving
functions Part-time From To

PART E: ACADEMIC/ PROFESSIONAL INTEREST & PURPOSE OF STUDY

Please outline your reasons for wishing to undertake your chosen programme of study.

(Please continue on a separate sheet if necessary)

PART F: PERSONAL STATEMENT

Please give your reasons for choosing Asia Pacific University of Technology & Innovation (APU) to further your study.

(Please continue on a separate sheet if necessary)

PART D: MEDICAL DISCLOSURE

1. Do you have any special/ medical condition that requires the attention of the University? Yes No
If yes, please indicate below:
Allergies Anemia Asthma Colour Blindness Epilepsy Heart Disease Others

2. Have you had any history of Mental/ Psychiatric conditions? Yes No

If Yes, kindly specify your medical conditions:

3. Have you been diagnosed with any conditions/ disorders that may affect your abilility to cope with University studies?
Yes No

Note (for International Students Only):

1. It is compulsory for all international students to purchase a health care plan and keep it valid throughout your academic study at APU. This will need to be purchased from EMGS.
2. Students from Yellow Fever Endemic Zones and other affected areas are required to have an International Health Certificate showing Yellow Fever Vaccination.
PART H: REFEREES
Please provide TWO (2) academic references from people (not a relative) who have direct knowledge of your study and/ or work.
Contact Fax Number
Name Company & Address Position Email
Number

PART I TO PART K: FOR INTERNATIONAL APPLICANTS ONLY

PART I: ENGLISH LANGUAGE PROFICIENCY
English was the language of instruction in my previous completed studies Yes No
I hold / have completed the English language qualification (s) listed below:
Name of Test/ Examination: Name of School/ College/ University: Date (to be) Taken: Results (if known):

PART J: MALAYSIAN IMMIGRATION INFORMATION

Are you currently holding any type of Malaysian Immigration Pass/ Visa?
Yes No
If yes, type of Immigration Pass/ Visa:
Social Visit Student Dependent Diplomatic
Expiry date if Immigration Pass/ Visa held (dd/mm/yyyy):

(Those transferring from other Institutions/ Colleges/ Universities in Malaysia and holding a Student Pass/ Visa or Dependent Pass will need to provide the School Leaving Certificate/
Testimonial, Release Letter, Results and Attendance Report/ Letter from the institution)

If you are a student/ former student of any Institution/ College/ University in Malaysia, please fill in the following:
Programme:

Institution/ College/ University:

Duration studied there: year(s)

PART K: ACCOMMODATION & ARRIVAL ARRANGEMENTS

Do you require APU to arrange your accommodation?
Yes No, I will arrange for my own accommodation
If yes, please fill up the APU Residence Application Form.
Do you wish for APU to arrange to pick you up from the airport? (only applicable for NEW applicants)*
Yes No

* Note:
1. This service is only available to students who hold a Valid Visa Approval Letter issued by Malaysian Immigration and who enter Malaysia via Kuala Lumpur International Airport
(KLIA/ KLIA2).
2. Notice for airport pick-up must be given at least 7 working days in advance by emailing the details to [email protected].
3. APU may not be able to arrange for airport pick-up and Immigration clearance should the required notice period not be provided.
 PART J: CONDITIONS FOR ENROLMENT
- Fees for the academic year are as set out in the fee guide.
- Payment by crossed cheque/ bank draft is to be made payable to Asia Pacific University Sdn Bhd or by bank transfer.
- Fee payment refunds are governed by the Fee Refund Policy as stated in the Fee Guide.
- Students must abide by all academic, administrative and examination rules and regulations and policies at APU.
- APU reserves the right to use your personal information in order to carry out its responsibilities in your personal and/ or academic interest as a student of APU.

PART K: IMPORTANT CHECKLIST

Malaysian Applicants International Applicants
Completed all sections of this application form (where applicable) Completed all sections of this application form (where applicable)
Attached certified certificates & transcripts Copy of all pages of passport including blank pages (Please ensure the copies are
Attached certified Forecast/ Trial results clearly copied and all page number can be seen clearly)
Attached photocopy of IC Attached certified copies of secondary or secondary vocational school
results/ transcripts from high school or/ and other higher institutions of
learning (if the documents are not in English Language, please provide certified
English translations)
Passport-sized photographs with WHITE background (35mm x 45mm)
EMGS Visa processing fees and administrative charges
Health Declaration Form

PART L: DECLARATION
1. I declare that all the particulars provided in this form are complete and correct. I understand that should any information in this form be found to be inaccurate/
incomplete my registration may be terminated by the University.
2. I agree to abide by APU’s Professional Code of Conduct, rules, regulations and policies.
3. I hereby agree to give consent to APU to release my academic reports/ results and attendance reports to my parents/ guardians/ sponsors as part of the APU’s
policies.
4. I have also read and understood APU’s FEE REFUND POLICY which is stated in the Fee Guide.
5. I hereby confirm that the documents I have submitted are genuine and authentic. I fully acknowdge and understand that APU has the right to amend or reverse
any decision with regard to my admission on the basis of incomplete, incorrect, fraudulent information or non-attainment of the minimum entry requirements to
join a specific programme.
6. I undertake to ensure that all fees are paid by the specified due dates, and failing which I agree to pay any late payment and/ or administrative charges incurred
after the due dates. If the fees are not received within 21 days from the due date, I understand that I may not be allowed to use the facilities at APU.
7. I hereby give permission to APU for the use of photographs, images and videos in publicity and promotional material and to release relevant information to our
University Partners, Career Centre, Alumni and and Government bodies or agencies as required.
Dengan ini saya memberi kebenaran kepada APU untuk kegunaan gambar, imej dan video dalam publisiti dan bahan promosi dan untuk memberikan maklumat
yang relevan kepada institusi yang bekerjasama dengan Universiti kami, Pusat Kerjaya, Alumni dan mana-mana badan kerajaan atau agensi-agensi seperti yang
dikehendaki.
8. By providing my personal data I consent to receiving information on courses, programmes and events that may benefit me.
Dengan menyediakan data peribadi saya, saya bersetuju untuk menerima maklumat mengenai kursus-kursus, program dan acara yang boleh memberi manfaat
kepada saya.

Signature: Name: Date:

FOR OFFICE USE ONLY: FEE PAYMENT DETAILS

Payment upon registration:
Mode of payment (upon registration)
1. Enrolment Fee
2. Registration Fee Cash Cheque Online Others
3. Course Fee Payment option: Full payment
4. Library Deposit (refundable) Installment- Semester
5. Engineering Laboratory Deposit (refundable) Installment- Monthly (for Malaysian Aplicants only)
6. EMGS & Application Fees (for International Students only) Note:
7. Personal Bond (for International Students only) 1. Payment by cheque/ Bank Draft is to be made payable to:
Asia Pacific University Sdn Bhd.
8. Others ___________________________________
2. For payments made by cheque, please indicate:
Total fees paid upon registration
Bank :
Registered by :
Cheque No. :
Date :

PERSONAL DATA PROTECTION NOTICE

We value your privacy and the protection of your personal data in compliance with the Personal Data Protection Act 2010, Malaysia.
This Personal Data Protection Notice explains:
• What kind of personal data we collect • How we store your personal data
• How we collect and handle your personal data • The choices we offer, including how to access and update your personal data
• Who we disclose your personal data to
I have read the Personal Data Protection Notice (www.apu.edu.my/pdpa_notice) ("Notice") and consent to APU, APIIT, APLC (as relevant) processing my personal data in accordance with the Notice. I also hereby warrant that I have
obtained all necessary consent from the third parties where I have provided their personal data as part of my application (such as information relating to my parents). I consent to any educational institution at which I have previously
been a student and/or my current or any past employer, providing APU, APIIT, APLC (as relevant) with information which they hold about me for the purpose of verifying my grades and/or qualifications and/or experience.
We may not be able to consider/process your application, or provide you with our services, or administer your contract/transaction with us if you choose not to supply us with the necessary personal data, or the data supplied to us
is insufficient or inaccurate.

DU030(W) AF(PG)/APU/JAN/2023/V1