Undergraduate application form - The University of Nottingham ...

Undergraduate application formPlease make sure that all the required fields are completed and all supporting documents are attached and sent to the addressgiven on the last page of the form.1. CourseThe course are you applying forProposed date of admission2. Personal detailsTitle: Mr Miss Mrs Ms Other (please specify)Forename/s (as per NRIC/passport)Surname/family name (as per NRIC/passport)Date of birth (day/month/year)D D M M Y Y Y YPassport/NRIC No.GenderMaleFemale Marital status Single MarriedFor Malaysian only Race ReligionNationalityCountry of permanent residenceCorrespondence address (please note this is the address to which the University will send all correspondence)TownState Postcode CountryEmail addressTelephone (daytime/work)(Evening/home)FaxMobilePermanent home address (if different from address above)TownState Postcode CountryEmail addressFaxTelephone (daytime/work) (Evening/home) MobileReference No.

3. Academic qualificationsAll applicants should enclose official transcript of their qualifications.Education from Year 10/Form 5:Name of institutionDate of attendance (month/year)Date started[M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y]Date awarded[M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y]Type of qualification4. Highest qualifications completed (examination for which result are known, including those failed)Have you obtained any other higher qualification than the above: YesYear started:[M][M][Y][Y][Y][Y]Year completed:[M][M][Y][Y][Y][Y]Type of qualification:Name of institution:Subject/sResult/grade/mark/bandSubject/sResult/grade/mark/band5. Qualification pending (examination to be completed or result pending)Year started:[M][M][Y][Y][Y][Y]Date to be completed[M][M][Y][Y][Y][Y]Type of qualification:Name of institution:SubjectsScore/gradeSubjectsScore/grade

6. English language qualifications(Enclose a copy of your English language qualifications. Please specify which test you have taken with the results and thedate you took the test/or will be taking the test)Others(please specify):Type of testScoreDate obtained[M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y][M][M][Y][Y][Y][Y]7. Personal statement supporting your applicationWhy have you chosen to study the programme you have applied for?What made you choose The University of Nottingham Malaysia Campus?What are your future plans?

8. OthersHow will your course be financed? (Self or sponsored. If sponsored, please give relevant details)SelfOrganisation/government sponsoredDo you have disability? YesNoIf yes, please provide further detailsDo you have any criminal conviction? YesNoIf yes, please provide further detailsWhere did you learn about The University of Nottingham Malaysia Campus and its programmes? (Please tick one box only)Advertisement(please state newspaper/journal)Radio Exhibition/careers fair Personal recommendation University brochureCareers office School Internet British CouncilCollege/institutionAgentPlease check that your application is complete and that you have enclosed all the relevant documentsTranscript of previous studies Copy of NRIC/passport English language qualification certificateApplication fee (for international applicants only)A signed and sealed academic reference form9. DeclarationI certify that the information provided above is correctSignatureDateD D M M Y Y Y YWhen completed please return to:Admissions OfficeThe University of Nottingham Malaysia CampusJalan Broga43500 SemenyihSelangor Darul EhsanMalaysiat: +6(03) 8924 8000f: +6(03) 8924 8002w: www.nottingham.edu.myThe University collects information about its students for various academic, administrative, health and safety reasons. The information is processed in accordance with theMalaysian Personal Data Protection (PDP) Act 2010, and is disclosed to third parties only with the individual's consent or to meet statutory obligation. The informationprovided on this application form will be stored electronically and used for administrative purposes by the University.

Undergraduate reference formPart 1: To be completed by the applicantPlease complete part 1 at the foot of this form (in BLOCK CAPITALS and black ink). Two reference forms are required when applyingfor postgraduate study.Send the reference forms to your referees requesting that the reference be completed. Once completed, your referees will need to sealthe reference in an envelope, sign across the seal on the back of the envelope and return the reference back to you. You should thensend your references in the sealed envelopes, along with the application form, to The University of Nottingham Malaysia Campus. We areunable to process your application without your references.Part 2: To be completed by the refereeThe person named below has applied to study at The University of Nottingham Malaysia Campus. Could you kindly provide us with areference on the applicant's academic and general suitability to undertake the proposed course of study by completing part 2 on thereverse side of this form, or by attaching to the form a written statement on letter-headed paper. It would be of great assistance if, inaddition to any general statement, you could indicate the following in your reference:(a) how long you have known the applicant and in what capacity(b) for applicants whose first language is not English, their standard of proficiency in written and oral English(c) the qualifications already obtained or expected to be obtained(d) how the applicant's achievements compare to those of his/her peers(e) the applicant's suitability for further study, including any distinct strengths or weaknessesYour reply will be treated in confidence by the University.Please return this form to the applicant in an envelope, signed across the seal to ensure confidentiality.Part 1: ApplicantYour name (as per NRIC/passport)Your addressProposed course and divisionProposed date of admissionName of referee

Undergraduate reference formThe University of NottinghamMalaysia CampusPart 2: Reference (please continue on a separate sheet if necessary)Name of refereeTitle/statusAddressTelephoneFaxEmailSignatureDatePlease provide the official stamp of the university/college or other official stamp.When completed please return to:Admissions OfficeThe University of Nottingham Malaysia CampusJalan Broga43500 SemenyihSelangor Darul EhsanMalaysiat: +6(03) 8924 8000f: +6(03) 8924 8002e: admissions@nottingham.edu.my (Malaysian applicants)int-admissions@nottingham.edu.my (international applicants)w: www.nottingham.edu.my