APPLICATION FORM

SECTION A: PROGRAMME DETAILS

Please select your choice of programme.

PROGRAMME*

SECTION B: PERSONAL DETAILS

Please complete all sections in this form in BLOCK letters.

Name (as per NRIC/passport)*
Nationality* MalaysianOthers (please specify)
Gender* Date of Birth*
NRIC No. (Malaysian Only) Race *
Passport No. (Non Malaysian) Religion*
Home Tel. No. Email*
Mobile Phone No.* Marital Status*
City* Postcode *

Full Address *
Country *

SECTION C: ACADEMIC BACKGROUND

SPM/O LevelUECSTPM/A LevelDIPLOMADEGREEMASTEROTHERS

Name of School / Institution

Academic Results (5 best subjects which must include Bahasa Malaysia, English, History and Mathematics)

Subject Grade
1.  
2.  
3.  
4.  
5.  
6.  
7.  
8.  
9.  
10.

SECTION D: SPORTS & CLUBS BACKGROUND

List down sports and clubs involvement during previous study:

Date Sports / Club Level (school / state / national) Best Achievement

SECTION E: PARENTS INFORMATION

Father's Name Mother's Name
Home Tel. No. Home Tel. No.
Mobile Phone No. Mobile Phone No.
Profession Profession

SECTION F: STUDENT VISA / PASS (FOR NON MALAYSIAN PASSPORT HOLDER)

Student with non Malaysian passport is required to have a student visa / pass to study in Malaysia. NIIT College will assist in processing the student visa / pass. We require the following information to process your visa / pass.

Nationality     Place / Country of Birth
Passport No.    Place / Country where passport was issued
Expiry Date         

(if your country does not issue passports, please state the name of the travel documents you intend to use)

Type of Immigration Pass / Visa SocialStudentDependentDiplomatic

Visa No. Expiry Date

SECTION G: ACCOMMODATION

Please indicate whether accommodation arrangement assistance is required or not.

Required *Not Required

* If required, please complete the accommodation form together with payment of deposit.

SECTION H: APPLICANT DECLARATION

Declaration by Student

I hereby accept and submit myself to the status, rules and regulations and ordinances (including By-Laws, codes and policies) of NIIT College and also the faculty or faculties in which I am registered and to any stipulated conditions prescribed by the management where applicable while I am a student at NIIT College and I promise to observe the same.
1. I confirm that the information contained in the application form is correct and I have read all the information (course outline, fees structure, application procedure, loan procedure) regarding the course that I enrolled.
2. I acknowledge that I have the responsibility to behave honestly, ethically and professionally in all of my dealings with NIIT College.
3. I agree to act in accordance with the regulations, status and disciplinary procedures of NIIT College.
4. I acknowledge that I am prevented from enrolling to any other institution once I submit my application form and also sign the student declaration that have been provided by NIIT College.
5. I further confirm and consent to the use by NIIT College without charge, my personal information in any publicity and / or promotional exercise within NIIT College including without limitation photographs . images or recordings, the publishing of examination results, the award of prize or scholarship and any achievement, academic or otherwise.

Student Name* NRIC / Passport No.*
Date *    

Declaration by parents/ guardian/ sponsor

I acknowledge that my child personal information (including photographs and any other information) are correct and I hereby apply for his/her admission to NIIT College as a full time student and I undertake all the cost of this programme until completion

Name * NRIC / Passport No. *
Relationship * Mobile No.
Date *    

DOCUMENT CHECKLIST

Documents submitted (Files may not exceed 4 MB each and all the documents uploaded must be legible)

The scanned document must be in JPEG, JPG, GIF, BMP, TIFF, PNG or PDF format only.

The scanned documents must be attached as ONE attachment.

(i) LOCAL STUDENT

Passport IC
Certified SPM/ UEC/ STPM/ A Level

(ii) INTERNATIONAL STUDENT

Passport sized photo
Passport (including cover)
Academic transcript with grading system
English test result
Original medical report