2.交换生申请表.doc

SOKONGAN PENGURUSAN PELAJAR DAN STAF ANTARABANGSA PUTRA INTERNATIONAL CENTRE (PUSAT ANTARABANGSA) Kod Dokumen: SOK/INT/BR01/INBOUND APPLICATION FOR STUDY IN UPM (INBOUND) (ALL ITEMS MUST BE FILLED) A. APPLICANT / PARTICIPANT PERSONAL DETAILS (COMPULSORY) Name (Mr./Mrs./Mi ss) Please stick passport sized picture here Date of Birth Age Place of Birth Race Gender Marital Status Male Female Married Single Citizenship/ Nationality Passport Number E-mail address Next of kin Religion Mobile Number Contact number Home address State & Country Postcode B. EDUCATION AT HOME UNIVERSITY (COMPULSORY) Current Home University (name & full address) Phone number Fax number E-mail address University web site Faculty which applicant is attached to at home university Degree Programme Degree Level Diploma Bachelor Current semester Master PhD NO. SEMAKAN : 00 NO. ISU : 01 TARIKH KUAT KUASA : 16/03/2018 4 1 drp. Current result (CGPA) C. Expected year of graduation STUDY IN UPM (COMPULSORY) Type of Mobility Exchange Programme (1 or 2 semester with credit transfer) Short Mobility Internship Programme Research attachment ASEAN International Mobility for Students (AIMS) Programme ASEAN University Network (AUN) Programme MEVLANA Exchange Protocol University Mobility in Asia and the Pacific (UMAP) Programme Others, please specify ______________________________________ Faculty / Institute applied in UPM Does this university have MoU with UPM? Period of study (in UPM) Yes No Commencing _______________________ to __________________________ Please specify your research project (if applicable) Transfer of credits required (Please fill in the Transfer of Credit Between Institution – Inbound Form) D. Yes No LANGUAGE Native Language Language proficiency English Proficient Moderate Weak Malay Proficient Moderate Weak Others (specify) Weak Proficient Moderate ______________________________________________ English Language Certificate or equivalent NO. SEMAKAN : 00 NO. ISU : 01 TARIKH KUAT KUASA : 16/03/2018 4 IELTS 2 drp. (please attach the document on your application) NO. SEMAKAN : 00 NO. ISU : 01 TARIKH KUAT KUASA : 16/03/2018 4 TOEFL Others (specify) _______________________________________________ 3 drp. E. INTER-OFFICE COMMUNICATION (COMPULSORY) Please include the contact person from the home university (international officer/student exchange coordinator) who is responsible for correspondence. affairs Name (Mr. / Miss / Mrs.) Position Office/Department Correspondence address Phone number Fax number E-mail address Signature & Stamp F. COURSE INFORMATION FOR TRANSFER OF CREDIT (to be completed by student) Fill in the course of the University Putra Malaysia to be taken in the space provided. No. Course Code NO. SEMAKAN : 00 NO. ISU : 01 TARIKH KUAT KUASA : 16/03/2018 4 Course Name Credit 4 drp. G. ACADEMIC ADVISOR INFORMATION (to be completed by the Dean of the respective universities) NAME OF HOME INSTITUTION: UNIVERSITI PUTRA MALAYSIA Name : Name : : Position : : Email Address : Positio n Email Address H. TO BE COMPLETED BY DEAN OF FACULTY I hereby support / not support the application for credit transfer. I hereby agree to offer the course requested by the candidate for transfer credit. HOME INSTITUTION: UNIVERSITI PUTRA MALAYSIA: Dean / Deputy Dean's signature and stamp: Dean / Deputy Dean's signature and stamp: Date : Date : I. Student Declaration I hereby declare that the information provided in this form is true. Signature : ____________________________________ Name : ____________________________________ Date: ________________________ NOTE: * Incomplete application form will not be processed ** Please submit copy of Academic Transcript, 2 current white colored photographs (passport size) and a copy of your passport (front page only) NO. SEMAKAN : 00 NO. ISU : 01 TARIKH KUAT KUASA : 16/03/2018 4 5 drp.