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INTEATIONAL ISLAMIC

UNIVERITY MALAYSIA

ADMISSION BOOKLET

CONTENTS

WELCOMING MESSAGE FROM THE DEAN, CPS


TERMS AND CONDITIONS OF OFFER
FEES - PROCESS AND PROCEDURES
ENROLMENT GUIDELINES
DEFERMENT/ REJECTION FORM
FINANCIAL DECLARATION FORM
HEALTH EXAMINATION GUIDELINES
MEDICAL CHECK UP FORM (MALAYSIAN AND INTERNATIONAL)

INTEATIONAL ISLAMIC
UNIVERITY MALAYSIA

ADMISSION BOOKLET

WELCOMING MESSAGE

DEAN
CENTRE FOR POSTGRADUATE STUDIES

Dear Student,
It is our great pleasure to welcome you as a new member of the IIUM
community. We are very pleased that you have been choosing IIUM to
embark upon an exciting journey to acquire knowledge and develop
skills with an Islamic Perspective. The University is committed to
provide wide ranging of postgraduate study opportunities for students
to realize their full indeed. We always strive to provide a high quality
and stimulating learning environment for our students.
We look forward to welcoming you to the International Islamic
University (IIUM) as a new student.
May Allah s.w.t bless all of us.
WELCOME TO THE GARDEN OF KNOWLEDGE AND VIRTUE

Thank you. Wassalam.

DEAN
Centre for Postgraduate Studies

INTEATIONAL ISLAMIC
UNIVERITY MALAYSIA

TERMS AND CONDITIONS OF OFFER


CONGRATULATIONS for being selected to join the International Islamic University Malaysia (IIUM).
All the information provided is to prepare you for enrolment at the Main Campus, Jalan Gombak, 53100 Kuala
Lumpur, Malaysia
Please read carefully and follow the instruction given.
ACCEPTANCE/REJECTION/DEFERMENT OF OFFER
Upon receiving the offer letter, you should respond to us on the offer of admission:
Accept (online via CPS website)/ Reject the Offer:

Click Accept via CPS website (online) or fill in the Rejection Form (if reject) and submit to the Centre for
Postgraduate Studies through mail/e-mail/fax.
Note: No further application will be entertained once you have rejected the offer.
If you accept but intend to defer our offer:

Fill in and submit the Deferment Form enclosed together with the Acceptance/Rejection Form and the
payment of RM100.00 (for International Candidate) and RM50.00 (for Local Candidate) as a deferment fee.
Note: These forms should reach us by the stipulated date as stated in the offer letter; otherwise the offer of
admission will automatically be revoked
LANGUAGE REQUIREMENTS
ENGLISH LANGUAGE
All new students are required to fulfill the English Language Requirement. (Please refer to Appendix A for details). If
this is not satisfied at the time of application, or before enrolment day, you are required to sit for IIUM English
Placement Test (EPT).
Exemption will be given only to the followings students:
a.
b.

Students who have graduated from the IIUM in a programme with English as the medium of instruction)
All candidates who have graduated from universities of English speaking countries
United Kingdom, United States of America, Australia, New Zealand and Canada

ARABIC LANGUAGE
Students who enroll into the programme that uses Arabic as the medium of instruction are required to fulfill the Arabic
language requirement (Please refer to Appendix A for details). If this is not satisfied, you are required to sit for IIUMadministered Arabic Placement Test (APT).
Exemption will be given to the followings students:
a. Students who have graduated from the IIUM in a programme with Arabic as the medium of instruction
b.

All candidates who have graduated from universities of Arab speaking countries

LANGUAGE PLACEMENT TEST


The EPT/APT will be conducted during the first week of the orientation programme. Failure in attending this test might
restrict you to successfully enroll as IIUM postgraduate students. If you do not fulfill the required band, you are
required to undergo Postgraduate Special Language programme before proceeding to the respective programme of
studies. (Tuition and academic administrative fees for this programme will be charged accordingly)
Note: An offer of admission issued to candidate who does not satisfy language requirement shall remain valid for a
period of two years. Should the applicant fail to attain the required scores within the two years, the offer of
admission shall be automatically withdrawn.

HEALTH REQUIREMENTS (for International Students only)


INTERNATIONAL STUDENTS
No cholera or smallpox vaccination certificate is required to be provided in order to enter Malaysia. However, yellow
fever vaccination is required from residents of South America and Africa (except South Africa). The health regulations
of the country require those arriving from the above-specified regions without the valid immunization certificate or
before the inoculation period, to be immediately quarantined for six days.
Please be informed that you are required to undergo a Medical Examination/Check-up in your respective country at the
authorized government hospital using medical check-up form as per attached. The Medical Examination/Check-up
report must be presented to the IIUM Health Centre during the medical check-up exercise conducted during the
orientation/Taaruf week. However, all international students are required to undergo a second screening at
IIUM Health Centre upon enrolment prior or during the week.
MALAYSIAN STUDENTS (Full-time Only)
All students are required to undergo medical check-up at the IIUM Health Centre on campus. However,
students are advised to bring their own X-Ray film with its report (to be done outside the campus).
Students are required to pay RM50.00 to the University (included in the Entrance Fee) as a medical check-up fee and
RM25.00 (cash term) if X-Ray carried out at IIUM Health Centre.
Note: The University health requirement stipulates that the students who wish to enroll into the university must be free
from HIV/AIDS, drug addiction or other serious disease which will be determined by the University authority. The
University has the right to revoke the admission of a student if he/she is found to be affected by such disease.
MEDICAL INSURANCE (for International Students only)
All International students are required to purchase medical insurance at the International Islamic University
Malaysian.
VERIFICATION OF THE ORIGINAL ACADEMICS CREDENTIALS
You are required to bring along the original documents/items of the following on the Enrolment Day:i.
Identify Card (Malaysian) OR Passport with validity of 2 years (International),
ii.
Bachelors Degree and Academic Transcript (for Master student)
iii.
Bachelors Degree, Masters Degree and Academic Transcript (for Ph.D students)
iv.
Two recent photographs measuring 3 cm 3.5 cm with your name, Matric No., and programme offered written
at the back of every photograph
(Academic credentials other than English language should be accompanied with English translation)
Important Note:
No candidate will be allowed to enroll without producing the original academic documents on the
Enrolment Day. If the University authorities discover any false declaration and the use of forged certificates
and documents by any candidates to gain entry into the university, this offer of admission will be revoked.
The university may at its absolute discretion take or cause any legal action to be taken against any student
guilty of committing forgery or fraud.

TAARUF (ORIENTATION) PROGRAMME (compulsory to all new students)


All students are required to attend Taaruf/Orientation programme conducted by the university and participate in all
the programmes organized by various bodies of the university.
CODE OF CONDUCT
Please refer to the following website for the details. (www.iium.edu.my/legalunit/articles-4)

ACCOMMODATION AND TRANSPORTATION


You are required to make the necessary traveling arrangement to Kuala Lumpur, Malaysia or specifically IIUM.
International candidates must ensure that your international passport has a validity period of at least 2 years.
The accommodation for postgraduate students in campus is not guaranteed. In case of early arrival (arrival prior to
the enrolment date), the students are advised to arrange your own accommodation.
Should you require further assistance on such arrangement, feel free to contact the related division:
Division
International Affairs Division

Details

Contact Details

Accommodation outside campus

+603-6196 5841/5843/5845

Transportation arrangement during


enrolment day

http://www.iium.edu.my/iad/

Student Affairs and

IIUM Residential College (Mahallah)

Development Division

For confirmation on the availability of rooms


for postgraduate students

+603-6196 4091/4095
http://www.iium.edu.my/life-iium/hostel-facilities

ADVICE FOR MARRIED STUDENTS


Should you fall in this category, you are advised to come alone to the University to undergo the process of enrolment,
orientation/Taaruf week and course registration. You may arrange to bring your spouse and children after you have
completed the necessary formalities. Otherwise, please be reminded that the university will not be responsible in
providing any assistance for such arrangement.

Appendix A
IIUM Language Requirement
(Postgraduate Students)

TYPES OF PROGRAMMES

MINIMUM
(ACADEMIC)

TOEFL

SCORE

MINIMUM IELTS SCORE (ACADEMIC)

Entry Requirements
PhD and Masters of English Paper based :600
Language/Literature
Computer based :250
Internet based :100
TYPES OF PROGRAMMES

MINIMUM
(ACADEMIC)

7.0
Overall band score

TOEFL

SCORE MINIMUM
IELTS/
(ACADEMIC)

EPT

SCORE

Graduation Requirements
Clinical programmes in Kulliyyah Paper based :550
of Medicine (KOM)
Computer based :213
Internet based :79

6.0
Overall band score

Entry Requirements
All Other programmes

Paper based :550


Computer based :213
Internet based :79

TYPES OF PROGRAMMES
MINIMUM
(by research only and thesis
(ACADEMIC)
written in Arabic language)

TOEFL

PhD. and Masters in the AIKOL , Entry Requirements*


IIBF, KIRKHS
Paper based :500
Computer based :173
Internet based :61
PhD. and Masters in the KOED

6.0
Overall band score
SCORE MINIMUM
IELTS/
(ACADEMIC)

EPT

SCORE

5.0
Overall band score

Entry Requirements*
Paper based :450
Computer based :133
Internet based :31

TYPES OF PROGRAMMES
PhD and Masters of Arabic Language/Literature/
Bilingual Programme

4.0
Overall band score

IIUM-administered Arabic Placement Test


Entry Requirements
7.0
Overall band score

INTEATIONAL ISLAMIC
UNIVERITY MALAYSIA

Fees process and procedures

1.
2.

Please make full payment of fees as per stated in the offer letter before the Enrolment Day. Refer to Appendix B.
Student is required to provide the following documents at the IIUM Finance Divisions counter during the Enrolment
Day.

Type of Students

Requirements
Guarantee Letter/Bank Statement/Statutory Declaration

Self Financed

(These documents are important to certify that the applicant have sufficient

Students

funds to cover all expenses throughout the studies)


To submit the bank in slip/ transaction slip for payment of semester fees as
stated inside the offer letter.

Sponsored

Original letter of offer from the sponsoring agency

Students
Ex-IIUM

All payments related to the previous programme have been settled

*Student should allocate sufficient funds for food, clothing, books, incidental expenses and necessary travel fare to
and from the University
Mode of Payment
Money Order/bank
Draft/Cheque

Details
Payable to:
FINANCE DIRECTOR INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA
Bank
Account No.
Bank Type

Bank Muamalat (M) Berhad


1407-0000005-71-9
UIAM Student Account

Beneficiary
Name
Bank
Account No.
SWIFT Code

FINANCE DIRECTOR INTERNATIONAL


MALAYSIA
Bank Muamalat (M) Berhad, UIAM Branch,
Jalan Gombak, Kuala Lumpur
1407-0000005-71-9
BMMBMYKL

Credit Card/Debit
Card

Online

http://epayment.iium.edu.my

MEPS Cash

Online

http://www.mepscash.com.my/payment/iium/

Bank Mualamat
Account

Online

http://www.i-muamalat.com.my

Direct bank in into


Universitys account

Bank Telegraphic
Transfer (TT)/Debit
Advise/Inter-bank
Transfer

ISLAMIC

UNIVERSITY

Remarks: Successful transaction slip/bank slip MUST be forwarded to the Finance Division counter on the enrolment day as
proof of payment.

Appendix B
IIUM Fees

(Postgraduate Students)

ENTRANCE FEES (MALAYSIAN)


MALAYSIAN
DESCRIPTION

NON EX-IIUM
FULL-TIME (MYR)

Orientation

EX-IIUM

PART-TIME (MYR)

FULL-TIME (MYR)

PART-TIME (MYR)

120.00

120.00

120.00

120.00

Registration

30.00

30.00

30.00

30.00

Matric Card

60.00

60.00

60.00

60.00

200.00

200.00

Alumni

100.00

100.00

Endowment Fee

150.00

150.00

150.00

150.00

TOTAL ENTRANCE FEES

660.00

660.00

360.00

360.00

English & Arabic


Placement Test*

* Each paper is RM100.00

ENTRANCE FEES (INTERNATIONAL)

DESCRIPTION

INTERNATIONAL
NON EX-IIUM
FULL-TIME (MYR)

Orientation

EX-IIUM

PART-TIME (MYR)

FULL-TIME (MYR)

PART-TIME (MYR)

120.00

120.00

120.00

120.00

Registration

30.00

30.00

30.00

30.00

Matric Card

60.00

60.00

60.00

60.00

Medical Check-up

50.00

50.00

200.00

200.00

Alumni

100.00

100.00

Endowment Fee

150.00

150.00

150.00

150.00

TOTAL ENTRANCE FEES

710.00

660.00

410.00

360.00

English

&

Arabic

Placement Test*

* Each paper is RM100.00

Students may be required to pay MYR 25 for X-Ray (carried out by the Universitys Clinic)

TUITION FEES FOR MASTERS PROGRAMMES (MALAYSIAN AND INTERNATIONAL)


MALAYSIAN
KULLIYYAH
Gombak Campus
CENTRE FOR LANGUAGES AND PRE-UNIVERSITY ACADEMIC
DEVELOPMENT (CELPAD)
KULLIYYAH OF ARCHITECTURE & ENVIRONMENTAL DESIGN
(KAED)
KULLIYYAH OF ENGINEERING (KOE)
KULLIYYAH
OF
INFORMATION
AND
COMMUNICATION
TECHNOLOGY (KICT)
AHMAD IBRAHIM KULLIYYAH OF LAWS (AIKOL)
KULLIYYAH OF ECONOMICS & MANAGEMENT SCIENCES (KENMS)
KULLIYYAH OF ISLAMIC REVEALED KNOWLEDGE & HUMAN
SCIENCES (KIRKHS)
KULLIYYAH OF EDUCATION (KOED)
KULLIYYAH OF LANGUAGES AND MANAGEMENT (KLM)
INTERNATIONAL INSTITUTE FOR HALAL RESEARCH & TRAINING
(INHART)
MSHIS-(Halal Industry Science)
MAHIM-(Halal Industry Management)
Kuantan Campus
KULLIYYAH OF MEDICINE (KOM)
KULLIYYAH OF MEDICINE (KOM) Clinical and Specialist Training
KULLIYYAH OF SCIENCE (KOS)
KULLIYYAH OF PHARMACY (KOP)
KULLIYYAH OF PHARMACY (KOP) Industrial Pharmacy
KULLIYYAH OF ALLIED HEALTH SCIENCE (KAHS)
KULLIYYAH OF NURSING (KON)
Kuala Lumpur Campus
INTERNATIONAL INSTITUTE OF ISLAMIC THOUGHT &
CIVILIZATION (ISTAC)
IIUM INSTITUTE OF ISLAMIC BANKING & FINANCE (IIiBF)

COURSEWORK
FEE/CRDT
HOURS*

FULL-TIME

INTERNATIONAL
THESIS

PARTTIME

FULL-TIME

COURSEWORK
PARTTIME

FEE/CRDT
HOURS*

THESIS
PARTTIME

FULLTIME

PARTTIME

600

600

600

600

600

600

600

600

90

1350

810

650

325

420

6300

3780

3750

1875

90
90

1350
1350

810
810

650
650

325
325

450
350

6750
5250

4050
3150

3800
3600

1900
1800

120
90
90

1920
1350
1350

1680
810
810

750
650
650

375
325
325

360
350
300

5760
5250
4500

5040
3150
2700

3250
3200
3000

1625
1600
1500

90
90

1350
1550

810
1010

650
650

325
325

350
300

5250
4700

3150
2900

3200
3000

1600
1500

90
90

1350
1350

810
810

650
650

1200
1200

450
300

6750
4500

4050
2700

3800
3000

2300
2000

280
90
90
90
90

4200
5000
1350
1350
28800
1350
1350

2520
810
810
810
810

2250
650
650
650
650

1125
325
325
325
325

700
400
500
400
500

10500
11900
6000
7500
43200
6000
7500

6300
3600
4500
3600
4500

5000
4000
5000
4000
5000

2500
2000
2500
2000
2500

90

1350

810

650

325

300

4500

2700

3000

1500

500

7500

4500

625

9375

5625

*The coursework fees are based on the maximum credit hour payable upon enrolment.
Full-time: AIKOL 16 credit hours; others 15 credit hours; Part-time: AIKOL 14 credit hours; others 9 credit hours
For student who register CELPAD course(s) during the period of studies will be charged accordingly, in addition to their respective programme fees (if applicable).
For full details of programme fees, please refer to Finance Division website (http://www.iium.edu.my/finance)
The university reserve the rights to adjust the tuition fee without prior notice

FULLTIME

OTHER FEES (MALAYSIAN AND INTERNATIONAL)


DESCRIPTION
Thesis Evaluation Fee
Health Medical Insurance (for International student only)

TOTAL

REMARKS
1000
300

Shall be paid during the final semester


Shall be paid every year

*The coursework fees are based on the maximum credit hour payable upon enrolment.
Full-time: AIKOL 16 credit hours; others 15 credit hours; Part-time: AIKOL 14 credit hours; others 9 credit hours
For student who register CELPAD course(s) during the period of studies will be charged accordingly, in addition to their respective programme fees (if applicable).
For full details of programme fees, please refer to Finance Division website (http://www.iium.edu.my/finance)
The university reserve the rights to adjust the tuition fee without prior notice

TUITION FEES FOR PhD PROGRAMMES (MALAYSIAN AND INTERNATIONAL)


MALAYSIAN
KULLIYYAH
Gombak Campus
CENTRE FOR LANGUAGES AND PRE-UNIVERSITY ACADEMIC
DEVELOPMENT (CELPAD)
KULLIYYAH OF ARCHITECTURE & ENVIRONMENTAL DESIGN
(KAED)
KULLIYYAH OF ENGINEERING (KOE)
KULLIYYAH OF INFORMATION AND COMMUNICATION
TECHNOLOGY (KICT)
AHMAD IBRAHIM KULLIYYAH OF LAWS (AIKOL)
KULLIYYAH OF ECONOMICS & MANAGEMENT SCIENCES
(KENMS)
KULLIYYAH OF ISLAMIC REVEALED KNOWLEDGE & HUMAN
SCIENCES (KIRKHS)
KULLIYYAH OF EDUCATION (KOED)
KULLIYYAH OF LANGUAGES AND MANAGEMENT (KLM)
INTERNATIONAL INSTITUTE FOR HALAL RESEARCH &
TRAINING (INHART)
KULLIYYAH OF MEDICINE (KOM)
KULLIYYAH OF SCIENCE (KOS)
KULLIYYAH OF PHARMACY (KOP)
KULLIYYAH OF ALLIED HEALTH SCIENCE (KAHS)
KULLIYYAH OF NURSING (KON)
Kuala Lumpur Campus
INTERNATIONAL INSTITUTE OF ISLAMIC THOUGHT &
CIVILIZATION (ISTAC)
IIUM INSTITUTE OF ISLAMIC BANKING & FINACE (IIiBF)

INTERNATIONAL

COURSEWORK
FEE/CRDT
HOURS*

THESIS

FULL-TIME

PARTTIME

FULL-TIME

COURSEWORK
PARTTIME

FULLTIME

THESIS
PARTTIME

FULLTIME

PARTTIME

600

600

600

600

600

600

600

600

220

3300

1980

1750

875

470

7050

4230

4700

2350

220
220

3300
3300

1980
1980

1750
1750

875
875

470
440

7050
6600

4230
3960

4700
4400

2350
2200

220
220

3520
3300

3080
1980

1800
1750

900
875

450
420

7200
6300

6300
3780

4500
4200

2250
2100

220

3300

1980

1750

875

400

6000

3600

4000

2000

220
220
220

3300
3300
3300

1980
1980
1980

1750
1750
1750

875
875
2000

420
400
470

6300
6000
7050

3780
3600
4230

4200
4000
4700

2100
2000
2350

250
220
220
220
220

3750
3300
3300
3300
3300

2250
1980
1980
1980
1980

2250
1750
1750
1750
1750

1125
875
875
875
875

1250
500
590
500
590

18750
7500
8850
7500
8850

11250
4500
5310
4500
5310

5900
5000
5900
5000
5900

2950
2500
2950
2500
2950

220

3300

1980

1750

875

400

6000

3600

4000

2000

4166.67

2500

4500

2700

*The coursework fees are based on the maximum credit hour payable upon enrolment.
Full-time: AIKOL 16 credit hours; others 15 credit hours; Part-time: AIKOL 14 credit hours; others 9 credit hours
For student who register CELPAD course(s) during the period of studies will be charged accordingly, in addition to their respective programme fees.
For full details of programme fees, please refer to Finance Division website (http://www.iium.edu.my/finance)
The university reserve the rights to adjust the tuition fee without prior notice

FEE/CRDT
HOURS*

OTHER FEES (MALAYSIAN AND INTERNATIONAL)


DESCRIPTION
Thesis Evaluation Fee
Health Medical Insurance (for International student only)

TOTAL

REMARKS
1000
300

Shall be paid during the final semester


Shall be paid every year

*The coursework fees are based on the maximum credit hour payable upon enrolment.
Full-time: AIKOL 16 credit hours; others 15 credit hours; Part-time: AIKOL 14 credit hours; others 9 credit hours
For student who register CELPAD course(s) during the period of studies will be charged accordingly, in addition to their respective programme fees.
For full details of programme fees, please refer to Finance Division website (http://www.iium.edu.my/finance)
The university reserve the rights to adjust the tuition fee without prior notice

INTEATIONAL ISLAMIC
UNIVERITY MALAYSIA

ENROLMENT GUIDELINES

Enrolment is the official process of registering the IIUMs students. During enrolment day, you are required to come to the
university in person. Below are summary of processes and forms to be completed or prepared for the enrolment day.
DETAILS
Acceptance/Rejection Form
Deferment Form
Payment of the related fees (as per stated in the offer letter)

REMARKS
To be submitted immediately after receiving the offer letter
To be submitted before the enrolment day
To be made before the enrolment day
Successful transaction slip/proof of payment is required to be
presented to the Finance Division Counter during enrolment day

Personal Identification
Passport with validity of 2 years (International) or
Identification Card (Malaysian)
2 recent passport size photos
Language Requirement

To be presented to academic verifiers during the enrollment day.


*Details as indicated in the Terms and Conditions of Offer

Original Academic Credentials


(Certificates/Transcript: other than English language should be
accompanied with English translation)
Financial Declaration Form
Medical Check-Up Form*
* Part-time Students: Not Applicable

To be presented to academic verifiers during the enrollment day.


* No candidate will be allowed to enroll without producing the
original academic documents on the Enrolment Day

IELTS and TOEFL result should be submitted to the Centre for


Languages and Pre-University Academic Development (CELPAD)
for verification during EPT/APT briefing (if any)

To be submitted during the enrolment day


International Students: To be completed before enrolment day
Malaysian Students: To complete Part 1 and 2 only

Workstation
Version
Revision
Effective Date

INTEATIONAL ISLAMIC
UNIVERITY MALAYSIA

CPS
01
00
31/03/2015

DEFERMENT / REJECT FORM


Dean
Centre for Postgraduate Studies, IIUM
Jalan Gombak, 53100 Kuala Lumpur, Malaysia
(Attn: Admissions & Records Management Unit, CPS)

Tel. No.: 603 61965205/5217/4021


Fax No.: 603 61965797/4163
NAME
MATRIC NO.
PROGRAMME

Please Tick () one of the followings:


1.

I do not accept the offer of admission (Please note that no further appeal or application will be entertained once
you have rejected the offer).

2.

I would like to defer the admission to next intake

Feb. 201__________

June 201__________
Sept. 201__________

Reason(s) for deferment:

A fee of RM100.00 (for International student) and RM50.00 (for local student) will be
charged as an administrative fee.

I accept all terms and conditions stated in the offer letter as well as in the appendices.

Signature of Student: .

Date: .

INTEATIONAL ISLAMIC
UNIVERITY MALAYSIA

Workstation
Version
Revision
Effective Date

CPS
01
00
31/03/2015

FINANCIAL DECLARATION
FORM

NAME
MATRIC NO.

PROGRAMME

1) I agree herewith and promise to pay all the fees mentioned in the Appendix as per
attached before enrolment, taking which the University reserves the right to take
necessary action against me.
2) I agree that the University has the right to deduct from my scholarship/financial
assistance given to me to settle the payments mentioned above.
3) I agree that the University has the right to revise the fees without any notification.
4) I fully understand and accept all other conditions as stated in the OFFER LETTER,
ADMISSION BOOKLET AND APPENDICES.
5) I attach herewith a copy of the sponsorship letter for record purpose (if applicable).

SIGNATURE OF STUDENT

DATE

INTEATIONAL ISLAMIC
UNIVERITY MALAYSIA

Health examination guidelines


FOR ENTRY INTO MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS
MALAYSIAN STUDENTS (FORM A) Applicable to full-time students only
1.
2.
3.
4.
5.
6.
7.
8.
9.

ALL FULL-TIME STUDENTS ARE REQUIRED TO UNDERGO MEDICAL CHECK-UP AT THE


IIUM HEALTH CENTRE ON CAMPUS
PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM
PLEASE FILL IN THE FORM IN ENGLISH LANGUAGE
PLEASE WRITE IN CAPITAL LETTERS
THIS FORM HAS FIVE (5) SECTIONS:
a. PART 1 AND 2 TO BE FILLED BY THE STUDENT; AND
b. PART 3, 4 AND 5 TO BE FILLED BY THE IIUM MEDICAL OFFICER ONLY
PLEASE BRING ALONG CHEST X-RAY FILM AND REPORT FOR REGISTRATION
PLEASE ENSURE THE X-RAY FILM IS LABELLED WITH YOUR NAME AND DATE TAKEN
CHEST X-RAY DONE WITHIN 6 MONTHS PRIOR TO REGISTRATION CAN BE
ACCEPTED
IN CASE YOU HACE CONSULTED ANY MEDICAL DOCTOR OTHER THAN THE IIUM
MEDICAL DOCTOR AND HAVE FILELD PART 3, 4, AND 5, THE UNIVERSITY/COLLEGE
RESERVES THE RIGHT TO REJECT FORM AND BE IRRESPONSIBLE IN COVERING
YOURSELF IN ANY EMERGENCY CASE

INTERNATIONAL STUDENTS (FORM: IIUM6-M)


1.
2.
3.
4.

PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE FORM


PLEASE FILL IN THE FORM IN ENGLISH LANGUAGE
PLEASE WRITE IN CAPITAL LETTERS
THIS FORM HAS FOUR (4) SECTIONS:
a. SECTION 1 (PART A AND B) TO BE FILLED BY THE STUDENT; AND
b. SECTION 2, 3 AND 4 TO BE FILLED BY THE EXAMINING DOCTOR
5. PLEASE COMPLETE ALL THE TESTS REQUIRED IN THIS FORM
6. THE UNIVERSITY/COLLEGE ONLY ACCEPTS MEDICAL EXAMINATION DONE WITHIN
60 DAYS BEFORE REGISTRATION OR WITHIN 30 DAYS AFTER REGISTRATION
7. PLEASE ATTACH ALL THE ORIGINAL LABORATORY RESULTS
8. PLEASE BRING ALONG CHEST X-RAY FILM AND REPORT FOR REGISTRATION
9. PLEASE ENSURE THE X-RAY FILM IS LABELLED WITH YOUR NAME AND DATE TAKEN
(IN ENGLISH)
10. CHEST X-RAY DONE WITHIN 6 MONTHS PRIOR TO REGISTRATION CAN BE
ACCEPTED
11. THE UNIVERSITY/COLLEGE RESERVES THE RIGHT TO REPEAT FULL MEDICAL
CHECK-UP OR ANY SPECIFIC LABORATORY TESTS SOULD THERE BE ANY DOUBT IN
THE MEDICAL REPORT SUBMITTED. ALL COSTS INVOLVED SHALL BE BORNE BY THE
STUDENT
12. THE UNIVERSITY/COLLEGE RESERVES THE RIGHT TO REJECT ANY APPLICATION:
a. BASED ON THE RESULTS OF THE HEALTH EXAMINATION; OR
b. SHOULD THERE BE ANY EVIDENCE THAT THE STUDENT HAS GIVEN FALSE
INFORMATION IN THE HEALTH EXAMINATION REPORT OR ANY SUPPORTING
DOCUMENTS

OFFICE OF THE HEALTH AND WELLNESS CENTRE

GAMBAR
PASPORT CALON

MEDICAL CHECK-UP FORM


(for Malaysian Students)

CANDIDATES
PASSPORT
PHOTOGRAPH

(Please complete Part 1 and 2 only. Part 3, 4, 5 is to bel filled by the IIUM Medical Officer only)

ARAHAN: SILA ISI DALAM HURUF BESAR


INSTRUCTION: PLEASE FILL IN CAPITAL LETTERS

BAHAGIAN 1
PART 1
TAHUN AKADEMIK/ACADEMIC YEAR

PROGRAM/PROGRAMME

SEMESTER

/
Seperti dalam Surat Tawaran/As in the Offer Letter

KULLIYYAH/FACULTY

NO.MATRIK/MATRIC NO
Seperti dalam Surat Tawaran/As in the Offer Letter

NAMA PENUH/FULL NAME

NO. KAD PENGENALAN/PASPORT/IDENTITY CARD/PASSPORT NO.

WARGANEGARA/NATIONALITY

UMUR/AGE

TARIKH LAHIR/DATE OF BIRTH

D
LELAKI/MALE

PEREMPUAN/FEMALE

BUJANG/SINGLE

KAHWIN/MARRIED

NAMA PENJAGA/NAME OF GUARDIAN

ALAMAT PENJAGA/POSTAL ADDRESS OF GUARDIAN

NO. TELEFON RUMAH/HOUSE TELEPHONE NO.

NO. TELEFON PEJABAT/OFFICE TELEPHONE NO.

BAHAGIAN 2 Sila tandakan (/) di kotak berkenaan


PART 2 Please tick (/) the relevant box
Adakah anda/keluarga mengalami: Lelah, batuk kering, darah tinggi, sakit jantung, kencing manis, sakit buah pinggang, gila
babi, sakit jiwa, penyalahgunaan dadah, kecacatan anggota, kanser, alahan, pembedahan?
Do you/family have the following: Asthma, tuberculosis, Hypertension, Heat Diseases, Diabetes Mellitus, Kidney Disease,
Epilepsy, Mental Illness, Drug Addiction, Deformity, Cancer, Allergic, Operation?
Tidak/No

Ya/Yes

Sendiri/Self
Keluarga/Family

Jika Ya, sila nyatakan/If Yes, please state: __________________________________________________________________


Saya dengan ini mengaku segala maklumat kesihatan yang dinyatakan di atas adalah benar.
(I hereby certify that the above mentioned information is true)

()
Tandatangan calon/Signature of candidate

BAHAGIAN 3
PART 3
1.

UNTUK DIISI OLEH DOCTOR YANG MEMERIKSA Tandakan yang berkaitan


TO BE FILLED BY EXAMINING DOCTOR
Tick if relevant

PEMERIKSAAN UMUM/GENERAL EXAMINATIONS


TINGGI/HEIGHT
sm/cm
NADIPULSE
a.
PALLOR
d.
JAUNDICE

b.
e.

seminit/per minute
CYANOSIS
LYMPH NODES

BERAT/WEIGHT
BP

kilogram
/

c.
f.

OEDEMO
SKIN

mmHg

2.

PEMERIKSAAN MATA/
EXAMINATION OF EYE
a. PENGLIHATAN TANPA KACA MATA/
UNAIDED VISION
b. PENGLIHATAN DENGAN KACA MATA/
AIDED VISION
c. FUNDOSCOPY
d.

3.

4.

5.

6.

PENGLIHATAN WARNA
COLOUR VISION

KANAN/
RIGHT

KIRI/
LEFT

CATATAN/
REMARKS
__________________
__________________

NORMAL
ABNORMAL
NORMAL
ABNORMAL

_____________
_____________

PEMERIKSAAN TELINGA/
EXAMINATION OF EAR

NORMAL
ABNORMAL

________________

RUANG MULUT/
ORAL CAVITY

NORMAL
ABNORMAL

________________

JANTUNG/HEART

NORMAL
ABNORMAL

________________

a. SISTEM RESPIRATORI/
RESPIRATORY SYSTEM

NORMAL
ABNORMAL

________________

b.X-RAY

NORMAL
ABNORMAL

________________

*LAMPIRKAN X-RAY DADA SERTA LAPORAN (filem besar)/


*PLEASE ATTACH CHEST X-RAY AND REPORT (large film)

TARIKH X-RAY DIAMBIL/


DATE OF X-RAY/TAKEN

D
7.

8.

9.

10.

TEMPAT DIAMBIL/
PLACE TAKEN

NO.RUJUKAN X-RAY/
X-RAY REF. NO

ABDOMEN & RONGGA HERNIA/


ABDOMEN & HERNIAL ORIFICES

NORMAL
ABNORMAL

________________

SISTEM SARAF DAN MENTAL/


NERVOUS SYSTEM AND MENTAL CONDITION

NORMAL
ABNORMAL

________________

SISTEM MUSKULOSKELETAL/
MUSCULOSKELETAL SYSTEM

NORMAL
ABNORMAL

________________

LAIN-LAIN/OTHERS____________________________________________________________________________________

BAHAGIAN 4
PART 4
11.

PEMERIKSAAN AIR KENCING/EXAMINATION OF URINE


Gula/Sugar

_____________

Albumin

_________________

Microscopy

________________

BAHAGIAN 5
PART 5
PENGESAHAN DOCTOR/Certification by Doctor
Sila tandakan (/) di dalam kotak yang berkenaan/Please tick (/) in the appropriate box

Saya mengesahkan bahawa pada hari ini telah memeriksa/I certify on this day I have examined
_____________________________________________________________No. K/P/I/C _____________________________
dan mendapati bahawa:
and found that:

Beliau tidak menghidapi apa-apa penyakit dan disahkan sihat


The above named is in good health

Beliau menghidap _______________________________________________________________


The above named has

Beliau sedang mendapat rawatan __________________________________________________


The above named is undergoing treatment

Tandatangan Doktor
Signature of Doctor

:____________________________________________________

Nama Doktor
Name of Doctor

:____________________________________________________

Kelulusan dan Cop Rasmi Klinik:

Qualification/Official stamp of hospital/clinic

Tarikh/Date

HEALTH EXAMINATION REPORT


FOR INTERNATIONAL STUDENTS

Passport size
Photo

PLEASE USE CAPITAL LETTERS


SECTION 1 (To be completed by candidates)
(PART A)
FULL NAME (As in passport)

INTERNATIONAL PASSPORT NO.

NATIONALITY

CONTACT NO

DATE OF BIRTH
D

AGE

SEX
MALE
FEMALE

ACADEMIC YEAR

MARITAL STATUS

SEMESTER

SINGLE
MARRIED

STUDENT ID/MATRIC NO

/
PROGRAMME OF STUDY

NEXT OF KIN

NEXT OF KINS ADDRESS

NEXT OF KINS CONTACT NUMBER

PROGRAMME CODE

SECTION 1 Please tick ( ) in the relevant box


(PART B)
Declaration of self and family illness. Explain in full if you or your family has any of the following illness.
*Immediate family refers to father, mother, brothers/sisters

MEDICAL PROBLEMS

SELF
Yes

IMMEDIATE FAMILY
No

Yes

No

If Yes please state

1. Congenital or inherited disorder


2. Allergy
3. Mental Illness
4. Fits, stroke, other neurological disease
5. Diabetes Mellitus
6. Hypertension
7. Heart or vascular disease
8. Asthma
9. Thyroid disease
10. Kidney disease
11. Cancer
12. Tuberculosis
13. Drug addiction
14. AIDS, HIV
15. History of surgery
16. Other illnesses

Current medication (Long term)


__________________________________________________________________________________________
__________________________________________________________________________________________
IMMUNIZATION HISTORY
1. Yellow Fear
2. BCG
3. Meningitis (Quadrivalent)
4. Hepatitis B
5. Others

DATE IMMUNIZED

I hereby certify that the information given above is true. I understand that my application will be rejected if there is
any false information given.

..
Date

.
Signature of candidate

SECTION 2 PHYSICAL EXAMINATION


(To be filled by examining doctor)

1. BASIC MEASUREMENT
HEIGHT
: ________
WEIGHT
: ________
VISION TEST : Unaided
Aided

:
:

m
kg
(R) _____
(R) _____

(L) _____
(L) _____

BLOOD PRESSURE
: _____
PULSE RATE
: _____
COLOUR VISION TEST
:
NORMAL/ABNORMAL

mmHg
/min

2. GENERAL EXAMINATION
ITEM

YES

NO

COMMENT

NORMAL

ABNORMAL

COMMENT

a. DEFORMITIES
b. PALLOR
c. CYANOSIS
d. JAUNDICE
e. OEDEMA
f. SKIN DISEASES

3. SYSTEMIC EXAMINATION
ITEM
a. EYES (including funduscopy)
b. EARS
c. NOSE
d. ORAL CAVITY/THROAT
e. NECK
f. HEART
g. LUNGS
h. ABDOMEN/HERNIA ORIFICES
i. NERVOUS SYSTEM
j. MENTAL CONDITION
k. MUSCULOSKELETAL SYSTEM

SECTION 3 INVESTIGATIONS
URINE TEST
ITEM

DATE TAKEN

RESULT

DATE TAKEN

RESULT

a. ALBUMIN*
b. SUGAR*
c. MICROSCOPIC*
d. MORPHINE**
e. CANNABIS**
f. AMPHETAMINES TYPE STIMULANT**

BLOOD TEST
ITEM
a. HEPATITIS Bs ANTIGEN
b. HEPATITIS C
c. HIV
d. VDRL/TPHA
e. MALARIAL PARASITE

CHEST X-RAY INFORMATION


CHEST X-RAY NO.
DATE TAKEN
PLACE TAKEN
REPORT

SECTION 4 CERTIFICATION BY THE EXAMINING DOCTOR


Please tick ( ) in the appropriate box:

I certify that I have on this date _______________ examined Mr./Ms. ___________________________________,


Passport No.: ______________________ and found him/her:

IN GOOD HEALTH
HAVING THE FOLLOWING MEDICAL COMPLICATION (S) (Please State)
__________________________________________________________________________________________

_________________________________________________________________________________
_________________________________________________________________________________
UNDERGOING TREATMENT FOR: (Please State)
__________________________________________________________________________________________

_________________________________________________________________________________
_________________________________________________________________________________

.
Signature if Doctor
Name of Doctor
Qualification
Hospital/Clinic
Registration No
Official stamp

Remarks by University Official:

..
Date
:
:
:
:
:

________________________________________
________________________________________
________________________________________
________________________________________

CENTRE FOR POSTGRADUATE STUDIES


INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA

In case of need, you can contact us through the followings:Telephone number :

+603-61964000 extension 4021, 5207 or 5217 (Office Hours)

Fax number

+603-61965797/4163

E-mail address

cps2u@iium.edu.my