Application Form Heriot-Watt University Malaysia

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1 FOR UNIVERSITY USE ONLY: Consultant: University use only Conditional Unconditional Rejected Date Approved by Signature Remarks Application Form Heriot-Watt University Malaysia PLEASE USE CAPITAL LETTERS ONLY Section A PERSONAL PARTICULARS PROGRAMME APPLIED FOR Programme Start Date (please check available dates) MM/YY Mode of study (please check whether a part-time option is available for your chosen programme) Full-time Part-time PERSONAL DETAILS Title (Dr / Mr / Miss / Mrs / Ms / Other) First Name (s) Family Name / Last Name Please affix a current colour passport photograph. This must be on a blue background. Date of Birth (DD/MM/YYYY) Gender Male Female Permanent Address Correspondence Address (if different) Residence Tel No: Office Tel No: Mobile No: Fax No: Address: Residence Tel No: Office Tel No: Mobile No: Fax No: Address:

2 Nationality Country of Birth Country of Permanent Residence Race Religion NRIC / Passport No. Date of Issue (DD/MM/YYYY) Date of Expiry (DD/MM/YYYY) VISA DETAILS Do you hold any immigration pass now? No Yes (please provide details below) Visa No. Date of Issue (DD/MM/YYYY) Visa Type Date of Expiry (DD/MM/YYYY) LEVEL OF ATTAINMENT IN ENGLISH If English is not your first language, please specify in the space below the standard you have attained. (eg IELTS) Formal Qualifications (GCSE or IELTS) Grade Date (MM/YY) Other experience of using the English Language (Please provide details) EMERGENCY CONTACT ACCOMODATION Do you need accommodation placement? YES NO OTHER INFORMATION Are you a member of staff at Heriot-Watt University Malaysia? YES NO Are you a spouse / child of a member of staff at Heriot-Watt University Malaysia? YES NO If the answer to the above is yes, state the name of the staff member SPECIAL ARRANGEMENTS Do you have any disability or impairment that may affect your studies? YES NO We need to know about any disability or impairment so that we can make sure that we can provide you with any additional support that you might need during your period of study with Heriot-Watt University Malaysia. CRIMINAL CONVICTION Do you have a relevant criminal conviction? YES NO To help the universities reduce the risk of harm or injury to their students caused by the criminal behavior of other students, they must know about any relevant criminal convictions that you have. Relevant criminal convictions are only those convictions for offences against the person, whether of a violent or sexual nature, and convictions for offences involving unlawfully supplying controlled drugs and substances where the conviction concerns commercial drug dealing or trafficking.

3 Section B EDUCATION BACKGROUND PREVIOUS ACADEMIC & PROFESSIONAL INFORMATION Please provide details of all qualifications Name of School/ Institution From To Title of Qualification Grades/CGPA/ Class of Degree Date Awarded EMPLOYMENT HISTORY (If applicable) Please enter present and any previous employment starting with the most recent. Please continue on a separate sheet if necessary. Employer Nature of Work/ Key responsibilities From Month Year To Month Year For programmes that require work experience, please enclose relevant documents as proof of employment to verify your employment history. Section C AGENT VERIFICATION (IF APPLICABLE) AGENT VERIFICATION (if applicable) Company Stamp:

4 SECTION D - TERMS AND CONDITIONS OF ENROLMENT Students are advised to read the policies and terms and conditions governing the admission to Heriot-Watt University Malaysia as set out below. Admission to Heriot-Watt University Malaysia is open to all individuals regardless of gender, race, religion, or nationality. Selection of admission is based on an overall assessment of the individual s potential. The university reserves the right to reject an application and to review a student s progress periodically. The university may at its discretion, cancel a student registration for lack of academic progress, failure to honour fees payable or failure to abide by the Rules and Regulations of Heriot-Watt University Malaysia. Fees payable for the academic year are as set out in the Fees Schedule. Please note that fees are normally reviewed on an annual basis and that the fees indicated on the current fees schedule may not be the fees applicable for subsequent semesters/terms. For the avoidance of doubt, Heriot- Watt University Malaysia has the right to revise the fee payable. All fees are payable in advance. Full settlement of first semester fee is required upon registration or by the intake date and according to the due dates for subsequent semesters as stated in the payment schedule. Payment of fees may be made by crossed cheque, telegraph transfer or bank draft in favour of HERIOT-WATT UNIVERSITY MALAYSIA SDN BHD Fees paid are not transferable and not refundable except in the circumstances set out below and provided that a request in writing for such refund is received. Any refund of fees or part thereof is subject to the following: a. The Registration Fee, International Student Application fee, International Student Annual Fee, and Education Malaysia Global Services (EMGS) application fee are not refundable under any circumstances. b. Subject to sub paragraph (a), if a student provides notice more than 2 weeks before the commencement of the semester, 100% of the tuition fees paid may be refundable. c. Subject to sub paragraph (a), if a student provides notice within 2 weeks before the commencement of the semester, 50% of the tuition fees paid may be refundable. d. Subject to sub paragraph (a), if a student provides notice within 2 weeks after the commencement of the semester, 50% of the tuition fees paid may be refundable. e. No fees are refundable 2 weeks after the commencement of the semester. f. Subject to sub paragraph (a) above, if a student is required to leave the programme due to medical reasons based on medical evidence,, the student will be eligible for a full refund of all fees paid. All refund whether of fees, deposits or whatsoever payments, shall be free of interest and shall be subject to the right of set-off by Heriot-Watt University Malaysia against any fees or whatsoever payments due and owing to Heriot-Watt University Malaysia. For all semesters, all fees are payable in advance and must be fully paid before or by the start date of the semester. An administrative charge of RM100 per week will be imposed commencing from the third week of the semester if payment in full is not received by the due date of each week or part thereof delayed. Heriot-Watt University Malaysia reserves the right to review the status and to take such necessary action as Heriot-Watt University Malaysia deems fit if payment is not received by the end of the fourth week of the semester. Such action may include the barring of the student from classes, examinations and facilities, suspension or termination of the student. In such circumstances, Heriot-Watt University Malaysia further reserves the right and shall be entitled to defer the marking of any examination paper, and to withhold all certificates and records of the student. No student with outstanding debt shall be permitted to graduate. In the event that a student is expelled or is suspended or discontinues the programme due to misconduct or any disciplinary matter or the nonattainment of academic requirement, there shall be no refund of fees paid. Students must abide by all academic, administrative and examination rules, regulations and policies of Heriot-Watt University Malaysia in force and to be enacted in future. Students are hereby advised that the rules and regulations governing the student whilst the student is enrolled as a student of Heriot-Watt University Malaysia may be viewed at Heriot-Watt University Malaysia website ( and is available for reading at the library. On admission as a student of Heriot-Watt University Malaysia, the student is bound by such rules and regulations regardless whether the student has acquainted himself/herself of such rules and regulations. Heriot-Watt University Malaysia reserves the right at anytime to elect new rules and regulations and to amend such rules and regulations to take effect immediately, and students are further advised to refer to Heriot-Watt University Website or at the library regularly for such amendments. In the interest of the student and/or other students of Heriot-Watt University Malaysia, the Head of School may at his or her discretion prohibit a student from attending classes or at the University for such period as the Head of School deems necessary in the event of the student having a contagious or infectious disease or illness or in the event of an outbreak of an contagious or infectious disease or illness at Heriot-Watt University Malaysia regardless whether the student is so infected or otherwise. No claim may be brought against Heriot-Watt University Malaysia (whether for a refund of fees or part thereof or otherwise whatsoever) arising from any such action taken. The award of scholarships, bursaries, grants, waivers, or financial assistance is at to the absolute discretion of Heriot-Watt University Malaysia. Section E - DECLARATION 1) I confirm that to the best of my knowledge the information given in this form is correct. I understand that any misrepresentation of information may result in Heriot-Watt University Malaysia revoking acceptance or terminating my enrolment. 2) I undertake that I will comply with all policies, rules and regulations of Heriot-Watt University Malaysia including those of respective departments. 3) I accept liability for payment of tuition fees in the absence of an awarding body and failure to pay any outstanding fees by the due date may lead to cancellation of my enrolment. 4) Heriot-Watt University Malaysia will use all reasonable endeavors to deliver courses and programmes of study as communicated to the students, and at the fee payment structures and fee levels published. It is possible, however, that some changes may occur and the University reserves the right to make variations to the content or method of delivery of courses, to discontinue or combine courses, to introduce new courses or to adjust fee payment structures or fee levels if at any time such action is considered to be reasonable and necessary. 5) I consent to the processing by the University of personal data (including sensitive personal data as defined in the Data Protection Act 2010 (when applicable) about me for the proper purposes of the institution. 6) I consent to share my data among Heriot-Watt University Malaysia, Heriot-Watt University and other subsidiaries for the purposes of programme administration. 7) I confirm that I have read and understood the terms and conditions governing the fee payment structures and fee levels for courses and programmes. I hereby apply for enrolment and if accepted, I agree to comply with the standard rules, regulations and ordinances of Heriot-Watt University generally and Heriot-Watt University Malaysia specifically. If I do not comply with any of the rules of the University, the University has the right to take disciplinary action against me. Signature Full name as per NRIC/Passport: Date Parent / Guardian signature (ONLY Applicable for students below 18 years of age) Signature Full name as per NRIC/Passport: Date

5 CHECKLIST: For Malaysian students or those who do not require a student visa to study in Malaysia Completed application form Originals or certified copies of certificates including certified translations if not in English Originals or certified copies of academic transcripts including certified translation if not in English Proof of employment (if applicable) Certified copy of NRIC or passport Two (2) passport sized colour photographs Registration fee of RM 500 payable to the bank account stated below CHECKLIST: For international students requiring the University s visa sponsorship Completed application form Originals or certified copies of academic transcripts including certified translation if not in English Originals or certified copies of certificates including certified translations if not in English Certified copies of passport (Every page include empty pages) (Valid at least 12 months before entry date) Two (2) passport sized colour photographs (with BLUE background) Personal bond payable to the university (Amount may varies among country. Please check with admissions) International Student Charge of RM 2650 (Inclusive of EMGS application fee, Insurance, Medical Screening, Student visa and administration fee) MODE OF PAYMENT: 1) Bank draft / cheque / postal orders payable to the bank account stated below 2) Direct bank-in to the bank account stated below 3) Cash is only accepted at the Admissions Office only BANK DETAILS: Payable to : HERIOT-WATT UNIVERSITY MALAYSIA SDN BHD Account No : Bank Name : Malayan Banking Berhad (Maybank) Bank Address : Floor 8, Menara Maybank, 100 Jalan Tun Perak, Kuala Lumpur, Malaysia Swift Code : MBBEMYKL

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