APPLICATION FORM

CITYU/SOP/AU/F01-1

Menara City U, No. 8, Jalan 51A/223, 46100 Petaling Jaya, Selangor.

Tel: +603-7949 1600 | Fax: +603-7957 7721 | E-mail: [email protected]
www.city.edu.my |

Intake

COURSE APPLIED
Master of Education (M.Ed.)
Master of Architecture (M.Arc)
Master of Architectural Management (M.ArcM)
Master of Accounting (M.Acc)
Master of Information Technology (MIT)
Master of Business Administration (MBA)
Master of Science in Business Administration (By Research) (MSc.BA)
Master of Mechanical Engineering (MME)
Master of Business Administration (MBA-ODL)
Master of Creative Industries And Communication (MCIC)
Master of Sport Studies (MSS)
Doctor of Business Administration (DBA)
Doctor of Education (Ed.D)
Doctor of Philosophy in Education (PhD-Ed)
Doctor of Philosophy in Design (PhD-Design)
Doctor of Philosophy (Business Administration) (PhD-BA)
Doctor of Philosophy in Information Technology (PhD-IT)
Doctor of Philosophy in Sport Studies (Phd-SS)
Doctor of Philosophy in Performing Arts (PhD-PA)
Doctor of Philosophy in Built Environment (PhD-BE)

SECTION A: PERSONAL PARTICULAR

Full Name (as per IC/Passport) :

NRIC : Gender :
Passport Number : Religion :
Date of Birth : Race :
Email : Age :

Correspondence Address : Nationality :

Tel :
Fax :
Mobile :

Employer’s Name :
Occupation :
Contact Number :
Employer’s Address :
SECTION B: EMERGENCY CONTACT

Name :
Contact Number : Mobile :
Relationship : Parents Brother/Sister Cousin Others :

SECTION C: ACADEMIC/PROFESSIONAL QUALIFICATIONS

Highest Examination Passed: SPM/ ‘O’Level STPM/ ‘A’ Level Diploma Bachelor Master

Others:

Exam Year Name Of Examination School/Institution Result

English Language Achievement

TOEFL IELTS MUET Others (Specify) :

SECTION D: WORKING EXPERIENCE (IF ANY)

Company Position From (Year) To (Year)

SECTION E: SUPPORTING DOCUMENT (INTERNATIONAL STUDENTS) Please attach the following when you submit your application

Health Examination
Complete Application Form Swift Code:
Payment for Visa (EMGS) & Application Fee MBBEMYKL
Photographs (passport-sized, white background)
Scan Copy of Passport - photocopy (cover to cover)
High School / Diploma / Degree / Master certificates & transcripts or result in English Language with certified true copy
Resend Resume/ CV (if applicable)
Payment can be done via Cash, Credit Card, Bank-In or Bank-Draft to be made payable to U.C.I Education Sdn. Bhd.

Payment Option 1: Flywire payment http://city-edu-new.flywire.com/ Account Name : U.C.I. EDUCATION SDN BHD
Name of Bank : Malayan Banking Berhad
Account Number : 5123 3433 4755
Payment Option 2: Maybank transfer Bank Address : 18A, Jalan 14/14, 46100 Petaling Jaya, Selangor
SECTION G: TERMS AND CONDITIONS FOR ADMISSION

Important
Students are advised to read carefully and understand fully the terms and conditions set out in Section I before proceeding to
the next section of this application form.

1. A student is considered fully enrolled upon subject enrolment 9. Fees paid are not transferable except under the
and payment of fees due in the semester (including deposits). circumstances stated below and provided with a written
2. Fees payable are shown in the programme fee structure. request (accompanied by official supporting documents)
Please note that City University reserves the right to review and that has been submitted to the Head of School or Director
revise fees annually. The fees indicated in the programme fee of Programme.
structure may not be applicable in the subsequent semesters • Transfer due to call for National Service.
(except the total tuition fee payable). • Transfer due to medical reasons.
3. Fees due in the semester must be paid in advance in the first 10.The refundable/transferable amount of fees or deposits
semester and before the first day of class in the subsequent is determined by Paragraphs 5 and 8, and after the
semesters. Failure to pay fees on time may result in the student deductions made against any fees or payments due and
being barred from classes, examinations and access to owing to City University.
campus facilities. 11.City University shall forfeit all payment paid by the student
4. No fees should be paid to anyone except to City University. or Sponsor;
No agent has been authorised to collect fees on City University’s a. If the Student remain inactive for 6 months without
behalf and City University will not be responsible to anyone notifying the Registrar in writing.
for any monies to any other party other than City University. b. In the event that a student is expelled/suspended or
5. Enrolment and General fees are NOT refundable and NOT discontinues the programme due to misconduct.
transferable (this includes approved and rejected applications). c. In the event that student drop all the subjects before
In addition: the ADD/DROP deadline and subsequently follow up with
a. The registration fee, application fee, student annual fee and a withdrawal from City University, City University will
Education Malaysia Global Services application fee are not charge back the full fees based on the initial approved
refundable nor transferable under any circumstances. course selection.
b. All initial fees paid as stipulated in the Letter of Acceptance / 12.In the event of non-payment or late payment of any fees or
Conditional Letter of Offer / Conditional Letter of Acceptance any part thereof without prior written approval from the
are not refundable. Registry, City University has the right without further notice,
c. For international students, no fees are refundable if the a. To charge administrative charges on each month of
student provides notices within two months before the default from the date of payment is due until the date of
commencement of semester. The commencement of the settlement of the fees and / or charge a reactivation fees;
semester is based on the date stated in the Visa. b. To bar the Students from classes, examinations and
6. Notice of withdrawal from the programme / deferment must access to campus facilities and / or withholding
be given 60 days prior to the commencement of the semester submission of answer scripts / assignment for making or
for a refund of a course fee to be considered. The administrative withholding examination results, transcripts or certificates
charge is applied. In the event that a student withdraws from and / or suspend provision of any services and / or take
the programme to join another educational institution after such action where it deems appropriate;
obtaining visa under City University, an administrative charge c. To suspend or terminate the student from the programme
of RM1,500 will be included for issuing of release letter. In the and subsequently proceed to cancel the student visa
event that a student fails to complete a course of study, City upon notifying the relevant authorities, i.e. police and
University is not obliged to return any part of the fees paid by immigration department and the respective embassy;
or on behalf of the student. d. To take such other recovery measures including
7. Refund of Tuition Fee (if any) to the student is after deduction commencing legal proceedings or referring to external
for any damage and / or loss suffered by City University due to debt collectors.
any fault or negligence of the student, free of interest. In order 13.A student on conditional offer whose actual results do not
to claim the refund; meet the entry requirements of the programme is eligible
a. The student is required to submit the relevant form for for a prorated refund of the tuition fees paid.
approval by City University within 15 days of completion of or 14.A copy of the City University Student Handbook has been
termination from the Program or approval to withdraw from posted on the portal. Students are expected to read and
the Programme. Failure to do so will result in the deposits abide by all rules and regulations of City University including
and advances being forfeited. policies on the use of campus facilities.
b. For graduated students, the relevant forms must be 15.City University reserves the right to review and amend the
submitted within 2 months from the convocation event. rules and regulations (including policies) at anytime.
c. All applications should ONLY be duly submitted in the
prescribed form.
8. A transfer fee of minimum RM300 is charged for every inter-
programme transfer.

End of this section

SECTION H: ACKNOWLEDGEMENT, AGREEMENT AND CONSENT
Applicant
1. I have read and fully understand all the terms and conditions 11. If tuition fees are paid by an organisation (“Sponsor”),
governing admission before submitting this application. I authorise City University to release fee and academic
2. I hereby declare that all information provided by me in this progress information to my Sponsor. I also consent to
form, including those information given in all other documents City University releasing fee and academic
submitted with this form, is complete, true and accurate. I also progress information to my parent or guardian.
acknowledge that City University reserves the right to vary, 12. I authorise and grant City University the right to use my
amend or reverse any decision regarding admission and personal information such as name, credentials, academic
enrolment made on the basis of non-attainment of minimum record, image and spoken and written records of my
entry requirements, incomplete or inaccurate information, activities at City University, in posters, leaflets, brochures,
including pre-requisite results to enrol into a programme. advertisements, websites, films, electronic recordings and
3. I understand that the Offer Letter issued to me will become void the like for marketing and promotion of City University’s
if I fail to submit all the relevant documents and pay the corporate image and programs of study, and / or any
required course fees by the due date. I agree to inform the purposes incidental to it.
Registrar in writing of any change in the information given 13. I understand and agree that City University and its
herein, and I understand that City University will not be liable authorised representatives shall unlimited use of, and
as a result of my failure to do so. exclusive rights, titles and interests including copyrights
4. I understand and agree that City University shall forfeit all over the materials mentioned in this Section, during and
payment paid by me or Sponsor if I remain inactive for 6 after my graduation from City University.
months without notifying the Registrar in writing. I understand 14. I understand and agree that if I revoke my consent to any
and agree that City University shall cancel my student Visa and of the items specified in clauses 12 and 13 herein, I must
notify the relevant government agencies / embassy / bodies if do so in writing to the Registrar and that all actions taken
I remain inactive for 6 months without notifying the Registrar in by City University prior to the revocation in exercise of
writing (This is applicable to foreign students only). their rights in respect of me will not be affected.
5. I understand and agree that any fees, deposits and / or 15. I understand and agree that City University shall release
monies due to me that remain unclaimed for a period of one my examination results and my academic record to my
year or more from the date ofmy becoming inactive in my parents as and
program of study, will be transferred to any nominated 16.a [ ] (please tick to indicate consent) I would like to
education or charitable fund without further reference to me. receive marketing materials from City Education Group
6. I understand and agree to use the technology resources and including future events, promotions, updates and any
facilities at City University for educational, academic, research other marketing activities.
and study purposes only and City University shall not be held 16.b [ ] (please tick to indicate consent) I would like to
liable for any violation of rules and regulations relating to receive marketing materials from City Education
those resources perpetuated by me. Group’s affiliates and its selected business partners
7. I have read the Personal Data Protection Notice. including future events, promotions, updates and any
8. I consent to City University processing my personal data other marketing activities.
(including sensitive personal data as defined in the Personal
Data Protection Act 2010) to assess my application, create an
enrolment record on the student database, undertake statistical
analysis and meet statutory reporting requirements. It will be
accessed strictly for these purposes only and disclosed to the
government agencies when required.
9. I also hereby warrant that I have obtained all necessary Signature of Student
consent from the third parties where I have provided
their personal data as part of my application (such as Name :
information relating to my parents) and I have extended a
copy of the Notice to the third parties.
10. I consent to educational institution at which I have previously
been a student and/or my current or any past employer,
NRIC :
providing City University with information, which they hold
about me for the purpose of City University verifying my
grades and/or qualifications and/or experience. Date :

SECTION I: FINANCIAL ASSISTANCE SECTION J: OTHER INFORMATION

Where did you hear about us?
EPF Withdrawal
Facebook Friends
Self Financing
Instagram Exhibition
Scholarship
Twitter Others :
Others :
Website

SECTION K: FOR OFFICE USE

MARKETING ADMISSION

Introducer Information Application Status

Name of Introducer : Date : Full Offer Conditional Offer Rejected
Verified by : Date :
Approved by HOD :

Remarks :