PHOTO
APPLICATION FORM
IMPORTANT
It is important that you complete ALL sections. Your application may be delayed if the form is incomplete.
Remember to attach all relevant additional information to your application.
Please complete in black ink and use BLOCK CAPITALS.
ADMISSION
You must obtain the following minimum scores in your five best subjects excluding Malay Language,
Islamic/Arabic/Moral Studies and Arts. We require you obtain A grades in at least five (5) main SPM/IGCSE subjects.
SPM
IGCSE
ARTS
English
Mathematics
3 other principals or core
subjects
A
A
B+ (in 2 out of the 3 principals B (in 3 principals or core
or core subjects with B in the subjects)
other)
SCIENCE
English
Mathematics
Additional Mathematics
A
A (but if not intending to
study Engineering : B)
A
A (but if not intending to
study Engineering : B)
Physics
Chemistry
Biology
E-mail : ________________________________________________
How did you find out about KYUEM?
Newspaper & Magazines
Education Fairs
KYUEM Website
Open Day
Other: ______________________________
(please specify)
Tan Sri
Puan Sri
Dato
Datin
Dr
Mr
Mrs
Ms
Father: ____________________________________________________________________________________________
NRIC/Passport No.: ___________________________________ Occupation: _______________________________
E-mail: _______________________________ Mobile No: _______________________Office No: ___________________
Title:
Tan Sri
Puan Sri
Dato
Datin
Dr
Mr
Mrs
Ms
Mother: ___________________________________________________________________________________________
NRIC/Passport No.: _____________________________________ Occupation: __________________________________
E-mail: _______________________________ Mobile No: _______________________Office No: ___________________
Guardian (if applicable): ______________________________________________Relationship: _______________
NRIC/Passport No.: ___________________________________Occupation: _______________________________
E-mail: _______________________________ Mobile No: _______________________Office No: ___________________
Subject
Grade
Subject
1.
7.
2.
8.
3.
9.
4.
10.
5.
11.
6.
12.
Grade
All tuition fees must be paid in favour of Yayasan UEM by a crossed cheque, money order or bank draft.
b)
Tuition fees are charged by semester with fees due at the beginning of each semester.
c)
Any tuition fees paid for a semester are not refundable in the event that the student chooses to withdraw from
the college for any reason.
d)
Any tuition fees paid for a semester are not refundable in the event that the college dismisses the student for
disciplinary offences or for failures in academic performance.
e)
I hereby confirm that the person or representative named in Section E (above) will pay any due fees by the
date(s) stipulated by the college in their current financial schedules(s) and that, if there should be a default in
the payment of such fees, then KYUEM will have the right to withdraw the facility of all services (academic and
otherwise) from the student named in Section A of this application.
f)
DATE
NO
YES
NO
YES
Diabetes Mellitus
Heart Disease
Hepatitis B
Bronchial Asthma
Kidney Disease
Hepatitis C
Hypertension
Psychiatric Illness
Malaria
Hearing Problem
HIV/AIDS
Colour Blindness
NO
Please identify any learning difficulties that you have or have had and outline any special learning/support that you have
received.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Please provide details of any medication that you are currently taking or have previously taken.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Have you been hospitalised in the past 2 years?
NO
_____________________________________________________________________________________________
I hereby give my consent for KYUEM to process my Personal Data (defined therein the PDPA) to review this application
and for the performance of the contract between me and KYUEM including to transfer my Personal Data to parties
relevant for the performance of the contract. This consent shall remain applicable as long as I maintain a contractual
relationship KYUEM until such time the consent is withdrawn.
I further confirm that I have secured the consent of parties named under Section C, for and on behalf of KYUEM, for
KYUEM to process their Personal Data (defined herein the PDPA) to review this application and for the performance of
the contract between me and KYUEM including to transfer their Personal Data to parties relevant for the performance of
the contract. This consent shall remain applicable as long as I maintain a contractual relationship KYUEM until such time
the consent is withdrawn.
Thank you.
SIGNATURE
DATE