Logo Application Form

International Student
Recent Passport Sized
Photograph
element = $this->elements['photograph']; echo $this->loadTemplate('element_no_label'); ?>


Section A : Course Details
Program Code* element = $this->elements['program_code']; echo $this->loadTemplate('element_no_label'); ?> Program Name element = $this->elements['program_name']; echo $this->loadTemplate('element_no_label'); ?>

Section B : Personal Details
Full Name*
(as in Passport)
element = $this->elements['full_name']; echo $this->loadTemplate('element_no_label'); ?>

PASSPORT NO.* element = $this->elements['passport_no']; echo $this->loadTemplate('element_no_label'); ?>

Gender* element = $this->elements['gender']; echo $this->loadTemplate('element_no_label'); ?> Marital Status* element = $this->elements['marital_status']; echo $this->loadTemplate('element_no_label'); ?>

Date of Birth* element = $this->elements['dob']; echo $this->loadTemplate('element_no_label'); ?> Age element = $this->elements['age']; echo $this->loadTemplate('element_no_label'); ?> Nationality* element = $this->elements['nationality']; echo $this->loadTemplate('element_no_label'); ?>

Race* element = $this->elements['race_int']; echo $this->loadTemplate('element_no_label'); ?> Religion* element = $this->elements['religion']; echo $this->loadTemplate('element_no_label'); ?>

Permanent Address* element = $this->elements['permanent_address_int']; echo $this->loadTemplate('element_no_label'); ?>

City* element = $this->elements['permanent_city_int']; echo $this->loadTemplate('element_no_label'); ?> State* element = $this->elements['permanent_state_int']; echo $this->loadTemplate('element_no_label'); ?> Country* element = $this->elements['permanent_country_int']; echo $this->loadTemplate('element_no_label'); ?>

Zip Code / Postcode* element = $this->elements['permanent_postcode_int']; echo $this->loadTemplate('element_no_label'); ?> Applicant Mobile No.* element = $this->elements['mobile_no_1']; echo $this->loadTemplate('element_no_label'); ?> element = $this->elements['mobile_no_2']; echo $this->loadTemplate('element_no_label'); ?>

Email ID* element = $this->elements['email_address']; echo $this->loadTemplate('element_no_label'); ?> Alternate Email ID element = $this->elements['alt_email_id']; echo $this->loadTemplate('element_no_label'); ?>

element = $this->elements['same_as_above_2']; echo $this->loadTemplate('element_no_label'); ?>

Correspondence Address* element = $this->elements['correspondence_address']; echo $this->loadTemplate('element_no_label'); ?>

City* element = $this->elements['correspondence_city']; echo $this->loadTemplate('element_no_label'); ?> State* element = $this->elements['correspondence_state']; echo $this->loadTemplate('element_no_label'); ?> Country* element = $this->elements['correspondence_country']; echo $this->loadTemplate('element_no_label'); ?>

Zip Code / Postcode* element = $this->elements['correspondence_postcode']; echo $this->loadTemplate('element_no_label'); ?> Resident Tel No.* element = $this->elements['resident_tel_no_1']; echo $this->loadTemplate('element_no_label'); ?> element = $this->elements['resident_tel_no_2']; echo $this->loadTemplate('element_no_label'); ?>

Section C : Family Information
In Case of Emergency, Contact:
Name* element = $this->elements['en1']; echo $this->loadTemplate('element_no_label'); ?> Name* element = $this->elements['en2']; echo $this->loadTemplate('element_no_label'); ?>
Relationship to you* element = $this->elements['erty1']; echo $this->loadTemplate('element_no_label'); ?> Relationship to you* element = $this->elements['erty2']; echo $this->loadTemplate('element_no_label'); ?>
Phone Number* element = $this->elements['epn1']; echo $this->loadTemplate('element_no_label'); ?> Phone Number* element = $this->elements['epn2']; echo $this->loadTemplate('element_no_label'); ?>
Mobile Number* element = $this->elements['emn1']; echo $this->loadTemplate('element_no_label'); ?> Mobile Number* element = $this->elements['emn2']; echo $this->loadTemplate('element_no_label'); ?>
Email Address* element = $this->elements['eea1']; echo $this->loadTemplate('element_no_label'); ?> Email Address* element = $this->elements['eea2']; echo $this->loadTemplate('element_no_label'); ?>

Section D : Passport Information
Passport Issue Place*
(as in Passport)
Passport Issue Date*
(as in Passport)
Passport Expiry Date*
(as in Passport)
element = $this->elements['pip']; echo $this->loadTemplate('element_no_label'); ?> element = $this->elements['pid']; echo $this->loadTemplate('element_no_label'); ?> element = $this->elements['ped']; echo $this->loadTemplate('element_no_label'); ?>

Section E : Academic Details (Examination Results of SPM/STPM)
Highest Academic Qualification* Year Taken* Name of Institution*
element = $this->elements['ero']; echo $this->loadTemplate('element_no_label'); ?> element = $this->elements['yt']; echo $this->loadTemplate('element_no_label'); ?> element = $this->elements['noi']; echo $this->loadTemplate('element_no_label'); ?>