UniMAP/UIT/PIT01 1

To all applicants Postgraduate Program Universiti Malaysia Perlis Thank you for choosing Universiti Malaysia Perlis ! While filling in the form , please pay attention to the following :

Fill in the form in block letters using a black pen or a typewriter ; All sections must be filled in. State “not applicable” wherever necessary.

The completed application form must be submitted with the following documents : i) Malaysian Applicants

Money Order of RM 50.00 for processing fee to ‘Bendahari UniMAP’. International Applicants Non-refunable processing fee of USD 30 in form of bank draft made payable to the ‘Bendahari UniMAP’.

ii) 2 certified copies degree/equivalent qualifications, Teaching English as a Foreign Language (TOEFL) / International English

Language Testing System (IELTS) or any other English tests that are equivalent, professional certificates and full Academics Transcripts. Applicants in their final semester of first degree must attach certified copies of result for every semester;

iii) Letter of undertaking for Scholarship/training award/study loan ; iv) Letter of approval/official leave from employer/relevant authorities to pursue this programme. v) Copy of research proposal (for research mode applicants) vi) Four (4) copies of every used pages of International passport and four (4) copies of passport-sized colored photograph for

student pass / visa application ; Please be informed that the acknowledgment letter must be completed and sent together with the application form. Only the completed form will be processed. Please address your application to : Dean Centre for Graduate Studies Universiti Malaysia Perlis 112 & 114 (First Floor) Block A Taman Pertiwi Indah Jalan Kangar – Alor Setar, Seriab

01000 Kangar Perlis MALAYSIA Looking forward to seeing you at UniMAP. Thank you.

CENTRE FOR GRADUATE STUDIES UNIVERSITI MALAYSIA PERLIS

UniMAP/UIT/PIT01 2

PERMOHONAN IJAZAH TINGGI POSTGRADUATE APPLICATION

A. BIDANG PENGAJIAN / FIELD OF STUDY Sila tanda ( ) di mana berkenaan / please tick ( )where applicable (i) Program yang dipohon Ph.D Sarjana Sains M.Sc/Ph.D PhD Industri Proposed Program Master of Science (Malaysian only) (Malaysian

only) (ii) Mod Pengajian Penyelidikan Mod Campuran Kerja Kursus Study Mode Research Mixed Mode Coursework (iii) Mod Pendaftaran Sepenuh masa Sambilan Registration Mode Full time Part time ______________________________________________________________________________________________________________________________________________________ I. Mod Penyelidikan (Research Mode)

Pusat Pengajian School

Program

* Tajuk Penyelidikan * Research Title

*Sila kepilkan cadangan penyelidikan anda bersama borang permohonan *Please enclose your research proposal with the application form

Penyelia Dicadangkan Proposed Supervisors

Penyelia Utama Main Supervisor

Penyelia Bersama Co-Supervisor

(1)

Penyelia Bersama Co-Supervisor

(2) Nama Name

Jawatan Post

Pusat Pengajian School

Please affix a

recent passport size photograph

PIT01

UNIVERSITI MALAYSIA PERLIS PUSAT PENGAJIAN SISWAZAH Centre for Graduate Studies

UniMAP/UIT/PIT01 3

II. Mod Campuran (Mixed Mode)

Pusat Pengajian School

Program

III. Mod Kerja Kursus (Coursework Mode)

Pusat Pengajian School

Program

______________________________________________________________________________________________________________________________________________________ B. BUTIR-BUTIR PERIBADI / PERSONAL DETAILS (sila taip atau tulis dalam HURUF BESAR / please type or write in BLOCK LETTERS)

1. Nama Penuh (mengikut kad pengenalan /pasport) Full Name (as written in identity card/passport)

2. No. Kad Pengenalan / Identity Card No 3. No. Pasport / Passport No.

4. Tarikh Lahir/Date of Birth 5. Umur/Age 6. Jantina / Gender / /

hari/day bulan/month tahun/ year 7. Taraf Perkahwinan / Marital Status Sila tanda ( )di mana berkenaan / please tick ( )where applicable Bujang/Single Berkahwin/Married 8. Kewarganegaraan / Nationality 9.Bangsa / Race

10. Alamat Tetap/ Permanent Address

Poskod/Postcode Bandar / City Negeri & Negara / State & Country

11. Alamat Surat- Menyurat / Correspondence Address Poskod/Postcode Bandar / City Negeri & Negara / State & Country

UniMAP/UIT/PIT01 4

No. Telefon / Telephone No. Rumah Home

Pejabat Office

Bimbit Cellular

Faks / Fax Emel / Email

WARIS TERDEKAT/ NEXT-OF-KIN (sila taip atau tulis dalam HURUF BESAR / please type or write in BLOCK LETTERS) 12. Nama / Name

13. Hubungan / Relationship

14. Alamat Surat - Menyurat / Correspondence Address Poskod/Postcode Bandar / City Negeri & Negara / State & Country

No. Telefon / Telephone No. Rumah Home

Pejabat Office

Bimbit Cellular

Faks / Fax Emel / Email

C. PENGALAMAN BEKERJA / WORKING EXPERIENCE

Tarikh / Date

Jawatan Dipegang

Position Held

Nama & Alamat Majikan

Name & Address of Employer Dari From

Hingga To

D. KELAYAKAN AKADEMIK / ACADEMIC QUALIFICATIONS

Universiti/Institusi University/Institution

Nama Ijazah Diperoleh Name of Degree Awarded

Tahun Masuk Year of Entry

Tahun Berijazah Year of Graduation

Kelas Kepujian/ PNGK atau setaraf*

Honours Classification /CGPA or equivalent*

* Untuk pelajar yang AKAN berijazah, sila nyatakan PNGK terkini / For GRADUATING students, state the latest CGPA

UniMAP/UIT/PIT01 5

E. KEMAHIRAN BAHASA INGGERIS / ENGLISH LANGUAGE PROFICIENCY Ujian / Test Tarikh / Date Gred/Skor

(Grade/Score) 1.

2.

3.

* Sila sertakan salinan keputusan yang telah disahkan / Attach certified copy of the results F. BANTUAN KEWANGAN / FINANCIAL SUPPORT Sila tanda ( )di mana berkenaan / please tick ( )where applicable

Biasiswa / Scholarship Saya dibiayai penuh oleh majikan / kerajaan negara saya (sertakan dokumen berkenaan) I am fully sponsored by my employer/ home government (attach relevant documents)

Saya dibiayai sendiri / oleh keluarga saya I am supporting myself / by my family

Lain – lain ( sila nyatakan) __________________________________ Others (please specify)

Sila kemukakan salinan penyata akaun bank yang disahkan/surat jaminan pembiayaan Please attach certified photocopy of statement of bank account/Letter of financial guarantee

Nama dan alamat penaja atau organisasi yang akan membiayai pengajian anda Name and address of person or organization sponsoring you

G. PENGALAMAN PENYELIDIKAN / RESEARCH EXPERIENCE Tajuk Title

Penganjur Organizer

Tempoh Duration

1.

2.

3.

4.

5.

UniMAP/UIT/PIT01 6

H. PENGADIL / REFEREES Sila nyatakan dua orang pengadil yang mengenali anda. Pastikan pengadil menggunakan borang laporan pengadil yang disertakan. Name two referees for your application. Ensure your referees use the referees report form attached. (1) (2) Nama/Name

Jawatan/Position

Alamat / Address

No. Telefon / No. Faks Telephone No./ Fax No.

Emel / Email

I. PERAKUAN / DECLARATION

Saya akui bahawa segala maklumat dan dokumen yang saya berikan adalah benar dan lengkap. Saya menyedari bahawa Universiti Malaysia Perlis berhak menolak permohonan saya / menarik balik tawaran kemasukan sekiranya maklumat serta dokumen didapati tidak benar dan tidak lengkap.

I hereby declare that all information and documents provided are true and complete. I acknowledge that Universiti Malaysia Perlis may reject my application / withdraw the offer of admission if the information and documents provided are found to be untrue or incomplete.

...................... .......................................... Tarikh /Date Tandatangan / Signature

UniMAP/UIT/PIT01 7

J. PANDUAN MENULIS CADANGAN PENYELIDIKAN / GUIDELINE IN WRITING RESEARCH PROPOSAL Sila rujuk lampiran PIT 01 – A seperti yang disertakan. / Kindly refer to attachment PIT 01 – A as included. Sila kembalikan borang yang lengkap kepada/ Please return the complete form to:

Pusat Pengajian Siswazah Universiti Malaysia Perlis (UniMAP)

No. 112 & 114 (Tingkat Satu) Taman Pertiwi Indah Jalan Kangar – Alor Setar, Seriab

01000, Kangar Perlis MALAYSIA Centre for Graduate Studies Universiti Malaysia Perlis (UniMAP)

No. 112 & 114 (First Floor) Taman Pertiwi Indah Jalan Kangar – Alor Setar, Seriab 01000, Kangar Perlis MALAYSIA

UniMAP/UIT/PIT01 8

Untuk Kegunaan Pejabat Sahaja / For Office Use Only

1. KELULUSAN PENGAJIAN IJAZAH TINGGI /POSTGRADUATE OFFICE APPROVAL Borang PIT01/PIT01 Form Borang PIT02/PIT02 Form (diisi oleh 2 orang pengadil (filled by 2 referees) 2 salinan ijazah yang disahkan /2 copies of certified degree 2 salinan transkrip yang disahkan /2 copoes of certified transcript 2 salinan ujian Bahasa Inggeris yang disahkan/2 copies of certifies English language test 2 salinan kad pengenalan yang disahkan /2 copies of certified identity card 2 salinan surat beranak yang disahkan /2 copies of certified birth certificate 4 Salinan pasport (untuk pemohon antarabangsa)/4 Copies of international passport(for international applicant) 4 keping gambar berukuran pasport (1 dilekatkan pada Borang Permohonan PIT01) /

4 copies of passport size photograph (1 is fixed to the Application Form PIT01) Yuran proses / Processing fee : RM 50.00 (Malaysian Applicant) / USD 30 (International Applicant) Dokumen pembiayan pengajian /sponsorship document Surat kebenaran sambung belajar dari majikan (pelajar Sambilan) / Letter of approval from Employer (Part Time

students) Cadangan Penyelidikan (calon Mod Pengajian) / Research Proposal (Research Mode candidate) Catatan Remarks ___________________________________________________________________ Tandatangan Pegawai / Officer’s Signature : ______________ Tarikh / Date : _____________ 2. PERAKUAN JAWATANKUASA IJAZAH TINGGI PUSAT PENGAJIAN /SCHOOL’S POSTGRADUATE STUDIES COMMITTEE APPROVAL BIL. _____________ Diterima untuk /Accepted for Mod Pendaftaran / Registration Mode Sarjana / Master Sepenuh Masa / Full Time

Doktor Falsafah / Ph.D Sambilan / Part Time Mod Pengajian / Study Mode Penyelidikan Research

Program Programme

Bidang Penyelidikan Field of Research

Tajuk Penyelidikan Research Title

Mod Campuran Mixed Mode

Program Program

Kerja Kursus Coursework

Program Program

Tandatangan Dekan Pusat Pengajian dan cop rasmi : ___________________ Dean’s Signature and official stamp Tarikh /Date : _____________

UniMAP/UIT/PIT01 9

PUSAT PENGAJIAN SISWAZAH UNIVERSITI MALAYSIA PERLIS

SENARAI SEMAK PERMOHONAN

(Application Check List)

Tandakan √ bagi perkara-perkara yang disertakan dalam ruang yang disediakan ( Please tick √ in the column for the documents which are enclosed )

No. Dokumen Yang Diperlukan ( Documents required )

Tandakan √ ( Tick )

1

Wang pos bernilai RM 50.00 sebagai yuran proses bagi pemohon Malaysia atas nama ‘ BENDAHARI UniMAP’ Non-refunable processing fee of USD 30 in form of bank draft made payable to the ‘Bendahari UniMAP’(for international students)

2

Borang Permohonan (PIT 01) yang lengkap diisi dan bertandatangan Complete and signed application form (PIT 01)

3

Empat (4) keping gambar dengan satunya dilekatkan di borang permohonan Four (4) copies of recent photograph , and one is fixed to the application form

4

2 salinan kad pengenalan, surat beranak, ijazah/kelulusan setaraf, sijil kelulusan profesional dan transkrip akademik lengkap serta sijil TOEFL/IELTS (pelajar antarabangsa) yang telah disahkan . Salinan sah keputusan peperiksaan akhir bagi setiap semester (bagi pemohon dalam tahun akhir pengajian ) 2 copies of birth certificate, certified degree/ equivalent qualifications professional certificates and full academic transcripts together with certificate of TOEFL/IELTS. Certified copies of results for every semester for applicants in their final year

5

Dua (2) salinan borang pengadil (PIT 02) daripada dua (2) orang pengadil Two (2) copies of referee form from two (2) referees

6

Empat (4) salinan setiap mukasurat pasport antarabangsa serta Empat (4) keping gambar berukuran pasport untuk urusan permohonan pas pelajar (bagi pemohon luar negara sahaja ) Four (4) copies of every page of the international passport and four (4) copies of passport sized colour photos for the student pass application process (for international applicants only)

7 Surat pengesahan pembiayaan pengajian (jika ada) Scholarship/training/study loan certification letters (if any)

8 Surat kebenaran sambung belajar bagi pelajar Sambilan (Mod Penyelidikan sahaja) Letter of approval/official leave from employer /relevant authorities to pursue this programme for Part Time students (Research Mode only)

9 Kertas cadangan penyelidikan (Mod Penyelidikan sahaja) Research proposal (Research Mode only)

NAMA (NAME)

PROGRAM (PROGRAMME)

PUSAT PENGAJIAN (SCHOOL)

TANDATANGAN (SIGNATURE)

*attach this checklist together with the complete application form

UniMAP/UIT/PIT01 10

RESEARCH PROPOSAL Name :

School :

Program : MSc Ph.D

Field of Research :

Proposed Supervisor (if any):

Title:

Problems statement:

Objective: Scope:

Research Description: (300 words)

PIT01-A

UniMAP/UIT/PIT01 11

Universiti Malaysia Perlis Centre for Graduate Studies 112 & 114, Block A, Taman Pertiwi Indah Jalan Kangar – Alor Setar, Seriab 01000,Kangar, Perlis MALAYSIA Tel: 6 04-979 8333/8331/8336

CGS LETTER OF ACKNOWLEDGEMENT

Applicant’s Name ………………………………………………………………………………………………. Applicant’s Address ………………………………………………………………………………………………. ………………………………………………………………………….............................. Country ……………………………………………………….. Postcode………………………… Degree Programme Applied For: Research Field …………………………………………………………………….. Mode of Study -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Dear Sir/Madam, Application for Admission to Postgraduate Programme We have received your application forms for PhD / Master in …………………………………………………………. 1. You will be informed as soon as a decision is made on your application. 2. We are unable to process your application because the following item(s) were not enclosed/have not been received: a. Processing fee of RM 50.00 of postal money (Malaysian applicants) / USD 30 of bank draft (international applicants)

b. Two (2) certified true copies of Degree Scroll/Academic transcript.

c. b. Other documents (as indicated below):

……………………………………………………………………………

Thank you. …………………………………… ……………………….. for Centre for Graduate Studies Date

PhD MSc

Research Mode

Mixed Mode

Coursework Mode

Please affix stamp here

MBA