Application Form The Starting Edge

Transcription

1 Application Form The Starting Edge 1. PERSONAL DETAILS Family Name/Last Name: Given Name(s): Passport Number or IC (if Malaysian): Nationality: Date of birth (dd/mm/yyyy): Age: Gender: Male / Female Home: 2. QUALIFICATIONS 2.1 GENERAL EDUCATION BACKGROUND Current Education Level (e.g. Secondary Form 5, High School Year 3) Institution Certificate Attained (e.g. PT3, O Level) Expected Certificate to be Awarded (e.g. SPM, A Level) 2.2 ENGLISH PROFICIENCY IELTS Test Results Date of Test Taken Others (Please state the test): Please attach your scanned test certificate with your application (if applicable). 1

2 3. EMERGENCY CONTACT DETAILS Name of Emergency Contact Person: Relationship to applicant: Home/Office: 4. PAYMENT DETAILS Will you be paying for the course yourself? 4.1 If YES, please use one of the following payment methods: - A. CREDIT CARD (MASTERCARD OR VISA ONLY) Step 1 : Go to Step 2 : Select the appropriate programme name in the Fees Name Step 3 : Make payment Step 4 : Attach payment slip to your registration form B. BANK TRANSFER (TELEGRAPHIC TRANSFER) OR DIRECT BANK-IN to either of the following banks: HSBC Bank Malaysia Berhad Bank Account Number: Swift code: HBMBMYKL Affin Bank Berhad Bank Account Number: Step 1 : Indicate the reference in your transaction slip Step 2 : Submit the registration form Attach proof of transaction to your registration form the copy to the correspondence address C. CROSSED CHEQUE OR BANK DRAFT payable to 'The University of Nottingham in Malaysia Sdn Bhd': Step 1 : Indicate the reference (Write the name of the remitter at the back of the cheque or bank draft and post to the correspondence address.) 2

3 Step 2 : Submit the registration form Attach an electronic-copy of your cheque to your registration form the copy to the correspondence address Please ensure that the fees are paid in full by April Failure to do so may result in the loss of your reserved spot. 4.2 If NO, please provide contact details of your sponsor, including any reference code your sponsor may require: - Sponsor Details Name: Reference code: Home/Office: 5. SOURCE Where did you learn about The Starting Edge? Internet University Employer Advertisement Friends Previous students Colleagues Others (please specify): 6. OTHER PERSONAL DETAILS 1. Are you a vegetarian? 2. Are you allergic to any food/medicine/environmental factors? 3. Are you under specific medication? 3

4 4. Do you have any disabilities? 5. For international students, will you be using our pick up services? (Please select) Airport pick-up (KLIA to campus) Airport drop-off (campus to KLIA) 6. OTHER INFORMATION 1. What would you like to learn in this course? Communication Listening Reading Writing Presentation Critical thinking Pronunciation Study skills Research Others (please specify): 2. The CELE Transition Programmes consist of The Starting Edge and The Leading Edge. In addition to The Starting Edge, what other module(s) would you be interested in? Digging in Deep Taking Centre Stage Learning the DIY Way Between the Lines Thinking like Sherlock Building Writing Blocks Gift of the Gab Wielding Words 1 Hear Me Out Wielding Words 2 3. What other courses would you like to attend? Networking Time management E-learning Note-taking Leadership and management 4. When would you like to attend these courses? Others (please specify): January April July October February May August November March June September December 5. Name three colleges/universities you would like to study in: a. b. c. 6. Which areas would you consider studying in the university? (You may tick more than one.) Arts & Design English Language & Literature Humanities Engineering Information Technology Medicine Health Sciences Psychology Sciences Agriculture & Forestry Environmental Sciences Accounting & Finance Business & Management Business & Management Education Economics Communication & Media Studies Law Politics & International Studies Sociology Others (please specify): 4

5 7. What are some of the extracurricular activities you participated in? (For example: St. John Ambulance, Interact Club, the English Society, Football Club, Chess Club etc.) 8. What career would you be interested in pursuing? 8. DECLARATION AND SIGNATURE I declare that the information supplied in this form is true to the best of my knowledge and belief. Signature:* Date: *You may be required to sign this form in person at the start of your course. *Please return your completed application form and the proof of payment to CELE The Edge Transition Programmes: english.summer@nottingham.edu.my Disclaimer: Although all possible care has been taken in the preparation of this form, no responsibility can be taken for any errors or omissions. Should a course need to be cancelled due to unforeseen circumstances, the applicant will be offered an alternative course or a full refund of tuition fees and accommodation deposit. FOR OFFICE USE ONLY: Application Number: Date Application Received: CEFR Score: 5