International Student Application Form

INTERNATIONAL STUDENT APPLICATION FORM



PROGRAMME

Program :
Year :
Month


STUDENT PERSONAL DETAILS (As listed in your passport)

Full Name : *
Passport No : *
Date Of Birth: *
 /  / 
Gender : *
Marital Status : *
Country: *
Religion :

Current Address (Home Country)

Address: *
Email Address : *
Phone: *
-

Current Local Address (if available)

Malaysia Address:

Emergency Contacts

Name :
Mobile :
-
Relationship:
Address :

Academic Qualifications (Secondary Educations)

Secondary School Attended :
From Year :
To Year :
Highest Qualification :

Academic Qualifications(TERTIARY EDUCATIONS )

University / College Attended :
From Year. :
To Year. :
Highest Qualification. :

Supporting Documents (Max size 3MB Format Type : jpg, jpeg, png, gif, doc, docx, xls, xlsx)

Copy of Passport :
Photograph (passport standard - Blue Background)
High School Results :
All Academic Results :
Medical Report (EMGS Format) :
No Objection Certificate (Sub Shara Countries) :
Others :

6.0 Application's Declaration

 

DECLARATION OF ACCURACY OF INFORMATION

  • I confirm that the information given above is factually correct and honestly presented to the best of my knowledge and belief.
  • I understand and accept that Kirkby International College reserves the right to reject my admission and enrolment on the basis of incorrect or incomplete information provided by me or by my agent.

 

Please view our student hand book 2016-2017
KIC-Students Hand Book 2016-2017
.
Word Verification:
Accept : *

The above information will be used to facilitate registration procedures, admisnistration, evaluation, statistical purposes and maintenance of academic history.

 Your personal information is protected and can be viewed upon request.

 We treat your personal information with respect.