TheYoung

CITY

Apprenticeship
Programme@ CityUC

Education Group

APPLICATION FORM | BORANG PERMOHONAN

City Education Group

Menara City U, No. 8, Jalan 51A/223, 46100 Petaling Jaya, Selangor.

Tel: 603-79491616 | Fax: 603-79491617 Email: cityedugroup@city.edu. my | www.city.edu.my

SECTION A : Personal Particulars | Maklumat Peribadi

NAME
(ASININMYKAD)
MYKAD)
NAME (AS

NAMA
(SEPERTI DALAM MYKAD)
D)

::

MYKAD NO.

GENDER

RELIGION

RACE

DATE OF BIRTH

AGE

EMAIL

NATIONALITY

HOME TELEPHONE NO.

HOME ADDRESS

NO.MYKAD

JANTINA

TARIKH LAHIR
EMAIL

NO. TELEFON RUMAH

ALAMAT RUMAH

AGAMA

MALE

FEMALE

LELAKI

PEREMPUAN

BANGSA
UMUR

KEWARGANEGARAAN

YEAR

TAHUN

MOBILE PHONE NO. :

NO. TELEFON BIMBIT

TOWN

BANDAR

POSTCODE

POSKOD

PARENT / GUARDIAN NAME :

NAMA IBUBAPA / PENJAGA

RELATIONSHIP

OCCUPATION

HOME TELEPHONE NO.

HUBUNGAN
PEKERJAAN

NO. TELEFON RUMAH

PARENTS

BROTHER / SISTER

IBUBAPA

OTHERS :

ABANG / KAKAK

LAIN-LAIN

MOBILE PHONE NO. :

NO. TELEFON BIMBIT

SECTION B : Emergency Contact | Talian Kecemasan

NAME (AS IN MYKAD)

RELATIONSHIP

NAMA (SEPERTI DALAM MYKAD)

HUBUNGAN

MOBILE PHONE NO. :

NO. TELEFON BIMBIT

PARENTS

BROTHER / SISTER

IBUBAPA

OTHERS :

ABANG / KAKAK

SECTION C : Academic / Professional Qualifications

LAIN-LAIN

| Kelayakan Akademik / Profesional

Highest Examination Passed | Kelulusan Peperiksaan Tertinggi

SPM

O-Levels

STPM

A-Levels

UEC

Diploma

Others :

SECTION D : Programme Applied | Memohon Program

Pre-U Programmes

Diploma

Pra-U Program
Diploma

Bachelor

Intake

Ijazah

Pengambilan

Cambridge A-Levels

Foundation

Cambridge A-Levels

SECTION E : Supporting Document

Asasi

| Dokumen Sokongan

Please attach the following when you submit your application.

Application Fee of RM200 | Yuran Permohonan RM200

(Please make RM200 Application Fee payment at any CIMB branch and forward a copy of the bank-in slip as verification).
(Sila buat pembayaran Yuran Permohonan sebanyak RM200 di mana-mana cawangan CIMB dan serahkan satu
salinan slip bank-in sebagai pengesahan).

City Academy Programmes

City University Programmes

:
:

| Pendaftaran

Please submit your application by :

Sila hantar borang permohonan anda ke :

Sila lampirkan seperti berikut apabila anda menyerahkan permohonan anda.

1.

SECTION F : Registration

CUST SDN BHD | CIMB 800 234 4549

U.C.I EDUCATION SDN BHD | CIMB 800 229 5164

1. Menara City U, No. 8, Jalan 51A/223, 46100 Petaling Jaya, Selangor.

2. Email. Scan in PDF format and send it to cityedugroup@city.edu. my
Emel. Scan di dalam format PDF dan dihantar ke cityedugroup@city.edu. my

SECTION G : Accomodation

| Penginapan

2.

Complete Application Form

Borang Permohonan yang lengkap

If you need accomodation

3.

4 Pcs Photography (passport size, full color)

4 Keping Gambar ( saiz pasport, berwarna)

SECTION H : Other Information

4.

Student and Parents MyKad with certified true copy

Salinan MyKad Pelajar dan Ibu bapa (yang disahkan benar)

Where did you get information about us?

5.

SPM transcripts or result with certified true copy

Salinan transkrip atau keputusan SPM (yang disahkan benar)

TV / Radio

Newspaper

Internet

6.

Updated resume (personal particulars, academic qualifications and working experience)

Kemaskini resume (butir-butir peribadi, kelayakan akademik dan pengalaman bekerja)

Exhibition

Offer letter

Others

SECTION I :

Yes | Ya

Jika anda memerlukan penginapan

No | Tidak

| Maklumat Lain

Dari mana anda mendapat maklumat mengenai kami?

TV / RADIO
Pameran

Suratkhabar

Surat Tawaran

Friends

Internet

Rakan

lain lain

Declaration | Pengakuan

I declare that the information provided by me in connection with this application is true and correct. I undertake to inform City University College of Science and Technology (City UC) immediately of any
changes in address, phone numbers and other information provided by me in this application. I understand that City UC reserves the right to vary decision regarding admission or enrolment on the
basis of incorrect or incomplete information. I hereby fully understood and agreed that all Fees Paid are NOT REFUNDABLE upon commencement and enrolment of the above course and to be bound by
the Terms and Conditions of the offer to study at City UC.
Saya mengaku bahawa maklumat yang diberikan oleh saya berkaitan dengan permohonan ini adalah benar dan betul. Saya berjanji untuk memaklumkan kepada City University College of Science and Technology (City UC)
serta-merta jika ada perubahan berkenaan dengan alamat, nombor telefon dan maklumat lain yang diberikan oleh saya di dalam permohonan ini. Saya memahami bahawa City UC berhak untuk mengubah keputusan
berkenaan kemasukan sekiranya maklumat yang diberi tidak betul atau tidak lengkap. Saya dengan ini memahami sepenuhnya dan bersetuju bahawa semua yuran pendaftaran yang dibayar TIDAK akan dikembalikan setelah
kursus bermula dan terikat oleh Terma dan Syarat tawaran untuk belajar di City UC.

Signature of Student / Tandatangan Pelajar

Name / Nama:

Signature of Parent or Guardian / Tandatangan Ibubapa atau Penjaga

Name / Nama:

Date / Tarikh