IEWM EDUCATION SDN BHD FOR OFFICE USE ONLYUnit 7, Ground Floor, UNTUK KEGUNAAN PEJABAT SAHAJAJalan 6/4 Kawasan Perindustrian Seri Kembangan, Student ID No. | No. ID Pelajar:43300 Seri Kembangan,Selangor Darul Ehsan,Malaysia

Intake | Pengambilan

DIPLOMADiploma In Engineering Technology (Trenchless Technology) (MQA/PA 4485)

Diploma In Engineering Technology (Subsurface Utility Engineering) (MQA/PA 4484)

Diploma In Infrastructure Asset Management (MQA/PA 5049)

Diploma In Total Quality Management (MQA/PA 5541)

Diploma In Business Management (MQA/PA 4483)

Diploma In Management Information System (MQA/PA 6634)

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IEWM/F/EDU/062Rev No.01

Employer's Address ofParent / GuardianAlamat Majikan Ibu/ bapa/Penjaga

RelationshipHubungan

ParentsIbubapa

Brother / SisterAbang / Kakak

OthersLain-lain

Date od BirthTarikh Lahir

AgeUmur

OccupationPekerjaan

Home Telephone No.No. Telefon Rumah

Mobile Phone No.No.Telefon Bimbit

APPLICATION FORMBORANG PERMOHONAN

Name (as in MyKad) Nama (seperti dalam

MyKad No.No. MyKad

Please attach yourpassport sized photograph here

(Sila lampiran gambar terkini)

YearTahun

EmailEmail

NationalityKewarganegaraan

Home Telephone No.No. Telefon Rumah

Mobile Phone No.No.Telefon Bimbit

Passport No. (If any)No. Pasport (Jika ada)

ReligionAgama

GenderJantina

MaleLelaki

FemalePerempuan

RaceBangsa

Home AddressAlamat Rumah

ReligionAgama

PostcodePoskod

Parent / Guardian NameNama Ibubapa / Penjaga

COURSE APPLIED | KURSUS YANG DIPOHON

SECTION A : Personal Particulars | Maklumat Peribadi

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SIJILCertificate In Islamic Quality Management

Certificate In Computer Science

Certificate In Food and Beverage

Certificate In Building Facility and Management

Certificate In Engineering Technology

Certificate In English Language

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Highest Examination Passed | Kelulusan Peperiksaan Tertinggi

SPM O-Levels STPM A-Levels Diploma Degree :

Year / Tahun

*Cut which are not related / Potong mana yang tidak berkaitan

Year / Tahun

*Cut which are not related / Potong mana yang tidak berkaitan

English Language Achievement | Pencapaian Bahasa Inggeris

TOEFL IELTS MUET :

Genre / Aliran : *Sciene/Literature *Sains/Sastera

Genre / Aliran : *Sciene/Literature *Sains/Sastera

Sijil Pelajaran Malaysia (SPM) / equivalent qualification recognized by the Malaysian Government

Sijil Pelajaran Malaysia (SPM)/kelulusan yang diiktiraf setaraf dengannya oleh Kerajaan Malaysia

Name Of Examination

Nama Peperiksaan

Bidang Pengajian / Kursus yang diikuti :

Examination Results / Keputusan Peperiksaan

Course of Study / Mata Pelajaran Grade / Gred Course of Study / Mata Pelajaran Grade / Gred

Home Telephone No.

No. Telefon Rumah

Mobile Phone No.

No.Telefon Bimbit

Others

Lain-lain

Result

Keputusan

Sijil Tinggi Persekolahan Malaysia (STPM)/Diploma / Matriculation / equivalent qualification recognized by the Malaysian Government (Years)

Sijil Tinggi Persekolahan Malaysia (STPM)/Diploma/ Matrikulasi/kelulusan yang diiktiraf setaraf dengannya oleh Kerajaan Malaysia ( Tahun)

Examination Results / Keputusan Peperiksaan

Course of Study / Mata Pelajaran Grade / Gred Course of Study / Mata Pelajaran

Name

Nama

Relationship

Hubungan

Parents

Ibubapa

Brother / Sister

Abang / Kakak

Others

Lain-lain

Others

Lain-lain

Grade / Gred

School / Institution

Sekolah / Institusi

SECTION B : Emergency Contact| Talian Kecemasan

SECTION C : Academic | Professional Qualifications | Akademik /Profesional

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Please attact the following when you submit your aplication | Sila bawa lampiran seperti berikut apabila anda menyerahkan permohonan anda

Application &Registration Fee of RM2100 | Yuran Permohonan & Pendaftaran sebanyak RM2100

Complete Application Form | Borang Permohonan yang lengkap

4 Pcs Photographs (passport size, full color) | 4 Keping Gambar (saiz pasport, berwarna)

MyKad Student and Parents with certified true copy | Salinan MyKad Pelajar dan Ibu bapa (yang disahkan benar)

SPM / STPM / Diploma / Degree / Master transcripts or result with certified true copy | Salinan transkrip atau keputusam SPM / STPM / Diploma / Ijazah / Ijazah Sarjana (yang disahkkan benar)

Updated resume (personal particulars, academic qualifications and working experience) | Kemaskini resume (butir-butir peribadi, kelayakan akademik dah pengalaman bekerja)

PTPTN MARA PERKESO Self Financing :

Yes | Ya No | Tidak

*Please obtain Hostel Information from Students A�airs | Sila dapatkan maklumat Hostel dari Hal Ehwal Pelajar

Where did you get information about us? | Dimanakah anda mendapat maklumat mengenai kami?

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: _______________________________Signature of StudentTandatangan Pelajar

DateTarikh

TV / RadioTV / Radio

Newspaper AdvertisementIklan bercetak suratkhabar

WebsiteLaman sesawang

FriendsKawan-kawan

Offer LetterSurat Tawaran

Others (Specify)

EPF WithdrawalOthers (Specify)Lain - lain

NameNama

AgeUmur

CareerKerjaya

SECTION D : Siblings (If Any) |Adik -beradik (Jika Ada)

SECTION E : Supporting Document (Local Students) | Dokumen Sokongan (Pelajar Tempatan)

SECTION F : Financial Assistance | Bantuan Kewangan

SECTION G : Accomodation | Penginapan*

SECTION H : Other Information | Maklumat Lain

SECTION I : Declaration | Pengakuan

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IMPORTANT: Please submit certi�ed true copies of IC, relevant academic transcripts / results for ALL quali�cations / academic studies, either currently enrolled, completed or discontinued, including failures (if any).

Privacy Statement

Your personal information collected in this form or otherwise provided in support of your application (“Personal Data”) is processed, retained and used by IEWM Education Sdn. Bhd. to assess your application for entry to a IEWM Education Sdn. Bhd. course, to create an enrolment record on the student database, to prepare statistical analysis and/or to inform you about your course and other IEWM course/events (collectively “Purpose”). If you do not complete all the questions on this form or do not consent to the processing of your Personal Data for the Purpose, IEWM Education Sdn. Bhd. will not be able to process your enrollment as a student of IEWM Education Sdn. Bhd. Your Personal Data may be collected from or disclosed to relevant bodies for the veri�cation of your grades, quali�cations and/or experience, the processing of your visa application and/or as otherwise required of IEWM Education Sdn. Bhd. by applicable laws or relevant authorities. Your Personal Data may also be disclosed to IEWM Education Sdn. Bhd.’s a�liates located outside Malaysia and/or other third parties for reasons related to the Purpose. IEWM Education Sdn. Bhd. may also retain and continue to process your Personal Data after your completion of the course enrolled for, or otherwise upon you ceasing to be a student of IEWM Education Sdn. Bhd., for archiving purposes, in relation to IEWM Education Sdn. Bhd.’s alumni events and activities and/or to maintain records of your grades, quali�cations and/or experience as may be required by IEWM Education Sdn. Bhd. and/or other institutions with whom you enroll for other courses hereafter. All documents that you provide to IEWM Education Sdn. Bhd. become the property of IEWM Education Sdn. Bhd. and will not be returned to you. You have the right to access or correct your Personal Data, or make inquiries or submit any concerns thereto, by contacting the Registrar O�ce of IEWM Education Sdn. Bhd. at info@iewmcollege.edu.my.

DECLARATION

I warrant that the information on this form, or provided in support of my application, is correct and complete. I acknowledge that the provision of incorrect information or the withholding of relevant information relating to my application, including academic transcript(s), might invalidate my application and that IEWM Education Sdn. Bhd. may withdraw an o�er or a place or cancel my enrollment in consequence thereof. Should IEWM Education Sdn. Bhd. determine that I have submitted a false document, I consent to IEWM Education Sdn. Bhd. disclosing this information to other relevant tertiary institutions.

I consent to any educational institution at which I have previously been a student and/or my current or any past employer, providing IEWM Education Sdn. Bhd. with information which that institution or employer holds about me for the purpose of IEWM Education Sdn. Bhd. verifying my grades and/or quali�cations and experience.

I agree to abide by the statutes, regulations and policies of IEWM Education Sdn. Bhd. at all times. I have read and understood the above conditions, and agree, authorise and accept them fully.

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