UNDERGRADUATE APPLICATION FORM

Please ensure that all the required fields are completed and all supporting documents are attached and sent to
either one of the addresses given on the last page of the form.

PART 1 : PROGRAM
Program Name:
School:
Campus:  Glenmarie, Selangor George Town, Penang Batu Kawan, Penang
Proposed Date of Admission :
Mode of Study:  Part Time Full Time
Application Status:  New  Transferred from another institution in Malaysia

PART 2 : PERSONAL PARTICULARS (CAPITAL LETTERS)

Full Name as per NRIC/Passport:
NRIC/Passport No.: Gender:  Male  Female
Date of Birth(DD/MM./YYYY) : Place of Birth:
Nationality: Marital Status:
Correspondence Address (P.O Box address is not accepted for international applicants)
Postcode:
Town/ City: State: Country:
Contact Number: Home Mobile Email Address:

PARENTS / GUARDIAN DETAILS

Name of Parents / Guardian:
Relationship:
Home Address: Occupation:
Town/ City: Postcode: State:
Contact Number: Home Mobile

Email Address: Tax Identification Numbers (TIN)

MOHE REQUIREMENT (FOR MALAYSIAN APPLICANTS ONLY)
Religion: Race:  Malay  Chinese  Indian  Pribumi  Others
Family Monthly Income: Parliament: Dewan Undangan Negeri (DUN):
To verify your Parliament and Dewan Undangan Negeri (DUN) representation, please refer to this link https://mysprsemak.spr.gov.my/semakan/daftarPemilih

FOR INTERNATIONAL APPLICANTS ONLY

If you have the following pass, please tick:
 Malaysian PR  Student  Dependent  Diplomatic  MM2H  Work Permit
 Others (please specify)  None
Immigration Pass Expiry Date (DD/MM/YYYY):

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PART 3 : ACADEMIC QUALIFICATIONS
Start Date End Date Institution Name and Location Qualification Obtained

English Language Proficiency

 please tick if the medium of instruction for your highest qualification achieved was in English. (A letter issued
by the university is required as proof for applicants whose first language is not English). If not, please
complete the table below and enclose a copy of your English Language qualification

Type of Test Year Obtained Score

PART 4 : OTHERS
Will your course be self-financed or sponsored? Please provide details of your sponsors
 Self  Organisation / Government Sponsor
Where did you learn about UOW Malaysia and its programs?
 Advertisement  Agent  Personal Recommendation  Website / Social Media  Open Day
 School Event  Public Education Fair

Do you have any medical condition that needs attention?

 Yes. Please provide details:
 No. I hereby declare that I am physically and mentally fit and there is no other medical condition or disability
likely to prevent me or require special attention or care in relation to study in UOW Malaysia.

PART 5 : UOW MALAYSIA RULES & REGULATIONS

1. Subjects Registration.
• You are required to enrol for the subjects within 7 days after the commencement date of the program.
• Enrolment after the stipulated date is subject to the approval from the Head of Academic Department.
2. Attendance & Results.
You are to maintain the following regulations mandated by the Ministry of Higher Education, Malaysia (MOHE):
• To maintain full-time studies status by registering NOT less than 3 subjects per semester.
• To attend all lectures, tutorials, practical and other classes required by the program.
• To maintain 80% of class attendance for each subject per semester. Failing which, you will be barred from the final
examination of the program.
• To maintain a minimum CGPA of 2.0 per semester.

International Students
1. Students Visa Application. Your acceptance to UOW Malaysia is subject to the approval of your student pass application
by EMGS & the Immigration Department of Malaysia. UOW Malaysia will not be held responsible for the time taken to
process your application and/or the rejection of your application by the relevant authorities.
2. Validity of Passport & Pass. You must hold a valid passport and student pass for the entire duration of your stay in Malaysia.
You are responsible for the validity of any kind of immigration pass/ and must abide by the rules and regulations imposed by
UOW Malaysia, MOHE and the Immigration Department of Malaysia.
3. Report to UOW Malaysia. You are to report to the International Office (IO), UOW Malaysia within 3 days of your arrival, to pay all
outstanding fees, to proceed for medical examination and submit your passport for endorsement of student pass.
4. Payment of Fee. You are required to report to the Admission & Bursary Office to pay the program fees and to present the
original certificate(s) and supporting documents within 7 days after the commencement date of the program (please refer to
UOW Malaysia's Bursary Policy).
5. Payment of Insurance, Medical Examination, Student Pass & Personal Bond. You shall bear all charges related to your
insurance/ medical examination/ student pass/ personal bond or penalty charges by EMGS & the Immigration Department of
Malaysia.
6. No Employment. You are not allowed to engage in any kind of work or occupation in Malaysia while holding a student pass
unless you have obtained written approval from the Immigration Department of Malaysia.
7. Extension of Student Pass. All application for extension of student pass must be submitted to the International Office 2
months before the expiry date of your student pass.
8. Withdrawal. You must inform UOW Malaysia in writing if you wish to withdraw from the institution and report to the
International Office for cancellation of your student pass. UOW Malaysia reserves the right to forfeit the caution fee, to make a
police report and inform the Immigration Department of Malaysia to cancel your student pass, if you fail to do a proper
cancellation before leaving the country.
9. Inactive. If you have registered but failed to attend any classes 1 month after the commencement date without informing UOW
Malaysia officially, you will be classified as having withdrawn. All fees and security deposit will be forfeited and UOW Malaysia
will inform the Immigration Department of Malaysia to cancel your student pass.
10. Refund of Fee. Refund of fees is subject to UOW Malaysia's Bursary Policy.
11. Deferment. You must obtain the written approval from your Head of Department if you wish to defer your studies (please refer
to UOW Malaysia's Bursary Policy). You have to return to home country during the deferment period.
12. Code of Conduct. You are required to abide by the UOW Malaysia Code of Conduct and Code of Discipline.

PART 7: STUDENT’S DECLARATION

I declare that the information provided and documents submitted are true and complete. I understand that any
misrepresentation of information may result in UOW Malaysia revoking acceptance or terminating my enrolment.

I further agree to abide by the UOW Malaysia Code of Conduct and understand that UOW Malaysia reserves the right to change
policies, programs and fees without notice. I understand that my study in UOW Malaysia is subject to the approval of my student
pass by the Malaysian Immigration Department (for international students only) .

I hereby confirm that I have read, agree to and confirm all the above. I understand that by accepting this offer, I am to follow all
the above terms and conditions as well as UOW Malaysia's Rules & Regulations. I fully understand and agree to abide by them.

I hereby consent to allow the institution to release relevant information pertaining to my academic performance to my parents/
guardians as and when needed.

Signature of Applicant Date

USE OF PERSONAL DATA

I, (NRIC / Passport No;)

hereby declare that the information in this application form is correct and complete. I have read the information and all terms and
conditions stipulated in this application form. I also consent to the use of the Personal Data for purposes as declared under
Personal Data Protection Notice as listed in https://www.uow.edu.my/personal-data-protection-notice.

UOW Malaysia may collect, process and use the information above to provide me with the latest information on products and
services offered by UOW Malaysia.

Acknowledged by: If you are under 18, your guardian / parent must sign below:

Name of Guardian / Parent:

Date: NIRC / Passport No:

Application form and all documentation should be sent to any one of the following UOW Malaysia’s Admission and Bursary
addresses where applicable.

University of Wollongong Malaysia, Glenmarie, Selangor Campus DU066(B)

Jalan Kontraktor U1/14, Seksyen U1, 40150 Shah Alam, Selangor.
+603 5565 0538
UOW Malaysia KDU College, Glenmarie, Selangor Campus DK280-01(B)
Level 5, Jalan Kontraktor U1/14, Seksyen U1, 40150 Shah Alam, Selangor.
+603 7953 6688
UOW Malaysia College, Glenmarie, Selangor Campus DK070(B)
Level 6, Jalan Kontraktor U1/14, Seksyen U1, 40150 Shah Alam, Selangor
+603 7953 6690
UOW Malaysia KDU Penang University College, George Town, Penang Campus DKU032(P)
32, Jalan Anson, 10400 George Town, Pulau Pinang.
+604 238 6368
UOW Malaysia KDU Penang University College, Batu Kawan, Penang Campus DKU032(P)
PMT 755, Persiaran Cassia Barat 3, 14110 Bandar Cassia, Pulau Pinang.
+604 563 6000

FOR OFFICE USE ONLY

Admission Status Student ID. No.:
Program Code: Entry level: Date of entry:
Category of acceptence:  Full  Conditional
Academic requirements for Conditional Acceptence
 To submit a copy of certified actual result
 Other conditions:
Remarks:
Counselled by: Signature: Date:

Recruited by:
 Agent Company name & stamp:

Admission process by: Signature: Date:

(Admission & Bursary Staff)

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