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Name *

Gender * Male Female

Date of Birth * Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - Month -------- 01 02 03 04 05 06 07 08 09 10 11 12 - Year -------- 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996

Nationality *

Address *

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Postcode

Country * - Select Your Country - Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Teritory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Island Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Island Colombia Comoros Congo Congo (DR) Cook Island Costa Rica Croatia Cuba Cyprus Czech Republic Czechoslovakia Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Island (Malvinas) Faroe Island Fiji Finland France France, Metropolitan French Guiana French Polynesia French S. Teritory Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard & Mc Donald Island Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libyan Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Island Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar North Korea Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Island Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Fed. Rwanda South Africa S. Georgia & S. Sandwich Island South Korea Samoa San Marino Saudi Arabia Saõ Tome & Principe Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Island Somalia Spain Sri Lanka St. Helena St. Kitts & Nevis St. Lucia St. Pierre & Miquelon St. Vincent & The Grenadines Sudan Suriname Svalbard & Jan Mayen Island Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Island Tuvalu United States U.S Minor Outlying Island Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Island (British) Virgin Island (U.S.) Wallis & Futuna Island Western Sahara Yemen Yugoslavia Zambia Zimbabwe

Telephone no. (Home) *

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Qualification (Highest) * SPM STPM O Level A Level IGCSE HGCSE
Higher School Certificate/Diploma Pre-University/Matriculation/IB
Foundation Diploma Degree

Others, please mention*

Interested in * - Select Your Course - Bachelor of Arts (Hons) in Accounting & Finance Bachelor of Science (Hons) in Business Information Systems Bachelor of Arts (Hons) in Business Management Bachelor of Arts (Hons) in Marketing Bachelor of Arts (Hons) in Graphic and Web Design Bachelor of Arts (Hons) in Graphic Design Bachelor of Science (Hons) in Computer Science Bachelor of Arts (Hons) in International Management Bachelor of Arts (Hons) in Tourism Management Bachelor of Science (Hons) in Computer Gaming & Animation Technology

What is your prefered pathway * - Please Specify - 3+0 (3 years in Malaysia) 2+1 (2 years in Malaysia, 1 year in United Kingdom) 1+2 (1 year in Malaysia, 2 years in United Kingdom)

How did you hear about us? * - Please Specify - ----- Advertisement Brochure Colleague Email Education Fairs Enquiry Flyer Friends Newspaper Poster Search Engine Students Web

When do you intend to enrol with us? * - Select Intake - ------ September 2009 February 2010

What would you like to know? *