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UNIVERSITI TUNKU ABDUL RAHMAN

Wholly owned by UTAR Education Foundation (Co. No. 578227 – M)

Application Form – January 2011 Intake

(Bachelor Honours Degree Programmes)

Section A: To be completed by applicant

I. PERSONAL INFORMATION

1. Name (as in NRIC): ___________________________________________________________

2. NRIC No: - - 3. Nationality: __________________
4. Date of Birth: _____________________________ 5. Gender: Male Female
(Day/Month/Year)

6. Address: ____________________________________________________________________
____________________________________________________________________________
Postcode: ___________________________ State: _______________________________
7. Contact No: (H)______________________ (H/P): _______________________________

8. E-Mail: _____________________________________________________________________

9. Race: Malay Chinese Indian Others _________________________

(Please specify)

10. Religion: Islam Buddhism Hinduism Christianity Others _________

(Please specify)

11. Do you suffer from any physical disability or illness? If so, please specify the nature of
these conditions. Otherwise, state “None”.
____________________________________________________________________________

II. COURSE APPLICATION DETAILS

You can select up to a maximum of 5 choices.

Please indicate your choice of course(s) in order of preference by writing down (1, 2, 3, 4, 5).
No Courses Offered Order of
Preference
Faculty of Arts and Social Science (Perak Campus)
1. Bachelor of Arts (Hons) English Language
2. Bachelor of Arts (Hons) English Education
3. Bachelor of Arts (Hons) Chinese Studies
4. Bachelor of Communication (Hons) Journalism
5. Bachelor of Communication (Hons) Public Relations
6. Bachelor of Communication (Hons) Advertising
7. Bachelor of Social Science (Hons) Psychology
No Courses Offered Course
Preference
Faculty of Business and Finance (Perak Campus)
8. Bachelor of Commerce (Hons) Accounting
9. Bachelor of Business Administration (Hons)
10. Bachelor of Business Administration (Hons) Entrepreneurship
11. Bachelor of Business Administration (Hons) Banking and Finance
12. Bachelor of Economics (Hons) Financial Economics
13. Bachelor of Marketing (Hons)
14. Bachelor of Finance (Hons)
Faculty of Science (Perak Campus)
15. Bachelor of Science (Hons) Biotechnology
16. Bachelor of Science (Hons) Chemistry
17. Bachelor of Science (Hons) Biochemistry
18. Bachelor of Science (Hons) Biomedical Science
19. Bachelor of Science (Hons) Statistical Computing and Operations Research
20. Bachelor of Science (Hons) Microbiology
21. Bachelor of Science (Hons) Logistics and International Shipping
Faculty of Engineering and Green Technology (Perak Campus)
22. Bachelor of Science (Hons) Construction Management
23. Bachelor of Engineering (Hons) Electronic Engineering
24. Bachelor of Engineering (Hons) Environmental Engineering
25. Bachelor of Engineering (Hons) Petrochemical Engineering
26. Bachelor of Engineering (Hons) Industrial Engineering
Faculty of Information and Communication Technology (Perak Campus)
27. Bachelor of Computer Science (Hons)
28. Bachelor of Information Systems (Hons) Information Systems Engineering
29. Bachelor of Information Systems (Hons) Business Information Systems
30. Bachelor of Information Technology (Hons) Communications and Networking
31. Bachelor of Information Technology (Hons) Computer Engineering
Faculty of Creative Industries (Petaling Jaya Campus)
32. Bachelor of Communication (Hons) Broadcasting
33. Bachelor of Arts (Hons) Graphic Design and Multimedia
34. Bachelor of Corporate Communication (Hons)
35. Bachelor of Media and Creative Studies (Hons)
36. Bachelor of Arts (Hons) Game Design
Faculty of Accountancy and Management (Sg.Long Campus)
37. Bachelor of Economics (Hons) Global Economics
38. Bachelor of International Business (Hons)
39. Bachelor of Accounting (Hons)
Faculty of Engineering and Science (Kuala Lumpur Campus)
40. Bachelor of Engineering (Hons) Electrical and Electronic Engineering
41. Bachelor of Engineering (Hons) Materials and Manufacturing Engineering
42. Bachelor of Engineering (Hons) Mechanical Engineering
43. Bachelor of Engineering (Hons) Biomedical Engineering
44. Bachelor of Engineering (Hons) Mechatronics Engineering
45. Bachelor of Engineering (Hons) Electronic and Communications Engineering
46. Bachelor of Engineering (Hons) Chemical Engineering
 No Courses Offered Order of
Preference
Faculty of Engineering and Science (Kuala Lumpur Campus)
47. Bachelor of Engineering (Hons) Civil Engineering
48. Bachelor of Science (Hons) Actuarial Science
49. Bachelor of Science (Hons) Applied Mathematics with Computing
50. Bachelor of Science (Hons) Physics
51. Bachelor of Science (Hons) Financial Mathematics
52. Bachelor of Science (Hons) Software Engineering
53. Bachelor of Science (Hons) Quantity Surveying
54. Bachelor of Science (Hons) Architecture
Faculty of Medicine and Health Sciences (Sg.Long Campus)
55. Bachelor of Chinese Medicine (Hons)

III. ACADEMIC QUALIFICATION

* Delete whichever is not applicable

1. Last School/Institution Attended

a) Name: ______________________________________________________________________

b) Address: ____________________________________________________________________

2. Qualification
a) * SPM/Others: ______________________________________________________
(Please specify)

No. Subjects Grade No. Subjects Grade

1. 7.
2. 8.
3. 9.
4. 10.
5. 11.
6. 12.

b) * STPM/A-Levels/SAM/CPU/UEC/Others: ____________________________
(Please specify)
No. Subjects Grade No. Subjects Grade
1. 6.
2. 7.
3. 8.
4. 9.
5. 10.

c) Other Qualification:

Name of Institution :
Level of Study :
Name of Award :
CGPA/Grade :
3. English Language Proficiency: (Please fill in your grade)
IELTS TOEFL ENGLISH 1119/O-LEVEL MUET

4. July Paper(s): (Please fill in your grade)

BAHASA MELAYU ENGLISH LANGUAGE MATHEMATICS

IV. CO – CURRICULUM ACTIVITIES

1. Sports :___________________________________________________________
2. Uniform :___________________________________________________________
3. Clubs/Societies :___________________________________________________________

V. PARTICULARS OF PARENT/GUARDIAN

1. Name of Parent/Guardian: _________________________________________________

2. Address of Parent/Guardian: ________________________________________________
__________________________________________________________________________
3. Relationship: ______________________________________________________________
4. Occupation: _______________________________________________________________
5. Contact No: (H) __________________________ (O) : ________________________

VI. DECLARATION BY APPLICANT

APPLICANT
I declare that the above information provided by me in connection with this application is true and
correct. I understand that Universiti Tunku Abdul Rahman reserves the right to withdraw the offer
of admission or ask me to leave the University at any time if such information is found to be false
or incorrect.

__________________________ _____________________ ____________

Name of Applicant Signature of Applicant Date

Section B: For Office Use

Date Received: Complete and Processed: Incomplete:

Processing fee of RM60.00

Certified true copy of SPM/STPM/A-

Levels/SAM/CPU/UEC results

Certified true copy of School Leaving Certificate

Birth Certificate/Identity Card

Others _____________________________

Name of Staff-in-charge: Date:

Remarks:
 VII. APPLICATION INSTRUCTIONS

Completed application form must be submitted together with the following documents:

1. Certified true copy of actual/forecast SPM/Other equivalent results;

2. Certified true copy of actual/forecast STPM/A-Levels/SAM/CPU/UEC/Other equivalent
results;
3. Certified true copy of School Leaving Certificate;
4. Certified true copy of Birth Certificate;
5. Certified true copy of Identity Card;
6. Certified true copy of MUET result (compulsory for STPM holders);
7. A non-refundable processing fee of RM60.00 in money order/postal order/bankdraft made
payable to “Universiti Tunku Abdul Rahman”. (Please note that personal cheque/cash is NOT
accepted);
8. Self-addressed envelope measuring 7” X 10” affixed with RM0.90 stamp; and
9. Self-addressed envelope measuring 3.5” X 6” affixed with RM0.60 stamp;
If you are using other equivalent qualification(s), for example, Diploma or Advanced Diploma
from a College/Institution/Polytechnic, you are also required to submit together with the
application form:
1. Certified true copy of Certificate of Awards;
2. Official academic transcripts;
3. Course structure and syllabi;
4. Official letter from Private College/Institution of Higher Learning on the Standard
Minimum/Accreditation from the Malaysian Qualifications Agency (MQA) formerly known as
National Accreditation Board (LAN); and
5. All relevant information and materials related to your previous studies from SPM onwards.
Applications submitted without the above documents will be processed for normal
admission without any consideration for credit transfer.
Please send the application form to:
Department of Admissions and Credit Evaluation
Universiti Tunku Abdul Rahman
PO Box 11384
50744 Kuala Lumpur

Please indicate “UTAR JANUARY 2011 INTAKE” on the top left corner of the envelope.

Acknowledgement Slip
(Please submit this slip together with the completed application form)

* Name: ______________________________________________________________________
* Address: ____________________________________________________________________
_____________________________________________________________________________
RE: APPLICATION FOR ADMISSION TO UNIVERSITI TUNKU ABDUL RAHMAN –
JANUARY 2011 INTAKE
This is to inform you that your application has been received by the University and is being
processed.
* To be completed by applicant Department of Admissions and Credit Evaluation