APPLICATION FOR ADMISSION

Instructions (Arahan): Please use CAPITAL LETTERS and black ballpoint pen. Sila gunakan ballpen hitam dan HURUFBESAR sahaja *Please refer to guidelines for code number. *Sila rujuk panduan untuk nombor kod.

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NO.

SECTION A: APPLIED PROGRAMME (PROGRAM DIPOHON) Please indicate the programme which you wish to enrol in: Sila nyatakan program yang ingin diikuti:

Executive Certificate Professional/Executive Executive Bachelors Executive Masters

Sijil Eksekutif Diploma Ijazah Eksekutif Sarjana Eksekutif

Diploma Eksekutif/

Profesional

Name of Programme

Nama Program

Continuing Professional

Development Programme

SECTION B: APPLICANT’S PARTICULARS (MAKLUMAT PEMOHON)

Full Name

Nama Penuh

IC No / Passport No

Gender / Jantina

Nationality / Warganegara

Date of Birth / Tarikh Lahir Date/ Month/ Year Tarikh/Bulan/Tahun

Status / Status Single / Bujang Married / Berkahwin Others / Lain

Highest Academic LCE/SRP/PMR/Junior Secondary SPM/O Level

Qualification / Tahap

STPM/A Level Matriculation/Foundation

Pendidikan Tertinggi

International Baccalaureate

Diploma/HND

Bachelor Master

Doctorate

Mailing Address / Alamat

Surat-Menyurat

Tel No (HP) / Tel Bimbit

Tel No (Home) / Tel Rumah

Email / Emel

Please fax or email the completed application form with required items to: (Sila hantar borang permohonan lengkap berserta perkara-perkara yang diperlukan ke): School of Professional & Executive Education (SPEED), Asia e University, Tingkat Bawah, Blok Utama, No 4 Jalan Sultan Sulaiman 50000 Kuala Lumpur Tel No: 1-300-300-238 Fax: +603 – 2711 0480 Email: speed@aeu.edu.my Website: www.aeu.edu.my

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SECTION C: EDUCATION BACKGROUND / PENDIDIKAN

Name of Institution Level Code Specialisation (If Any) Year of Graduation CGPA Nama Institut Kod Tahap Bidang (Jika Ada) Tahun Tamat

SECTION D: EMPLOYMENT BACKGROUND / LATAR BELAKANG PEKERJAAN

Position Name of Employer Employer Address Start Date End Date Jawatan Nama Majikan Alamat Majikan Tarikh Bekerja Tamat Bekerja

Total Working Experience Years

Pengalaman Kerja Tahun

SECTION E: DECLARATION / PENGAKUAN I declare that the information given in this form is true and correct; I understand that my application can be rejected if I have submitted incorrect or incomplete information with false documents. Saya mengakui bahawa semua maklumat dan dokumen yang diberikan adalah benar dan lengkap. Saya

memahami bahawa sekiranya ada di antara maklumat ini didapati palsu atau tidak lengkap, permohonan saya

boleh ditolak.

……………………………………………. Date : Applicant’s Signature Tarikh Tandatangan Pemohon

.................................................................................................................................................................................. Please fax or email the completed application form with required items to: (Sila hantar borang permohonan lengkap berserta perkara-perkara yang diperlukan ke): School of Professional & Executive Education (SPEED), Asia e University, Tingkat Bawah, Blok Utama, No 4 Jalan Sultan Sulaiman 50000 Kuala Lumpur Tel No: 1-300-300-238 Fax: +603 – 2711 0480 Email: speed@aeu.edu.my Website: www.aeu.edu.my

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OFFICE USE ONLY / UNTUK KEGUNAAN PEJABAT SAHAJA

Documents are Complete Qualified

Remarks

ITEM CHEKLIST / SENARAI SEMAK PERKARA

Only completed applications will be processed. The following items must be submitted together

with application form.

Hanya borang yang lengkap sahaja akan diproses. Berikut adalah perkara-perkara yang perlu

dihantar bersama borang permohonan.

NO REQUIRED ITEMS / ITEM DIPERLUKAN TICK / TANDA 1 Certified true copy of academic transcript.

Transkrip akademik yang disahkan.

(SPM /STPM/STAM/CERTIFICATE/DIPLOMA/DEGREE) 2 A copy of NRIC / Passport.

Salinan kad pengenalan / Pasport.

3 3 passport size colour photograph (3.5 cm X 5.0cm) with light blue background and name written on reverse. 3 gambar warna berukuran pasport (3.5 X 5.0 cm) berlatarbelakang biru muda berserta nama ditulis di belakang gambar.

Please fax or email the completed application form with required items to: (Sila hantar borang permohonan lengkap berserta perkara-perkara yang diperlukan ke): School of Professional & Executive Education (SPEED), Asia e University, Tingkat Bawah, Blok Utama, No 4 Jalan Sultan Sulaiman 50000 Kuala Lumpur Tel No: 1-300-300-238 Fax: +603 – 2711 0480 Email: speed@aeu.edu.my Website: www.aeu.edu.my

APPENDIX II