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APPLICATION FOR GRADUATE ADMISSION

FOR MASTER OF SCIENCE AND DOCTOR OF PHILOSOPHY(BY RESEARCH)


(USE CAPITAL LETTERS)
APPLICATION ONLY
A. PLEASE TICK THE GRADUATE PROGRAMME APPLIED FOR:
1. Please describe your proposed research topic and submit a 3-4 page synopsis of your Please
STRUCTURE Tick
research proposal (in not more than 300 words). List your problem statement, research PROGRAMME OF STUDY
objectives, literature review and methodology (Please use a separate sheet). I II III 
1 Master of Science (Engineering) 
2. Kindly indicate the name of any academic that you may have communicated in OUM
2 Master of Science (Business Administration) 
who is willing to supervise your research project (optional) 
3 Master of Science (Science)
4 Doctor of Philosophy (Engineering) 

5 Doctor of Philosophy (Business Administration) 


6 Doctor of Philosophy (Information Technology) 

7 Doctor of Philosophy (Science) 


8 Master of Education 

9 Doctor of Philosophy (Education) 

APPLICATION PROCEDURES 10 Master of Business Administration 

11 Master of Management 

Master of Information Technology 


12
CHECKLIST 13 Master of Multimedia Communication 

14 Master of Environmental Science (Integrated Water Resources Management) 


15 Master of Information Science (Competitive Intelligence) 
1. Please use black ballpoint pen in CAPITAL letters only.
16 Master of Human Resource Management 

2. All sections of the form must be completed and the declaration signed and dated. 17 Master of Project Management 

18 Master of Software Engineering 


3. Enclose 1(one) certified copy of Identity Card (IC)/Passport. 
19 Master of Instructional Design and Technology

Master of Nursing 
20
4. Enclose 1(one) certified copy of all academic certificates and transcripts.
Note: STRUCTURE I- Degree By Research STRUCTURE II- Degree By Coursework and Research STRUCTURE III- Degree By Coursework
5. Enclose a non-refundable application fee of RM50.00 (for Malaysian) or RM100 (for non-Malaysian)
in the form of bank draft/money order/postal order made payable to UNITEM. B. PERSONAL PARTICULARS

Full Name
6. Proposal/Outline (for Structure 1 only)

Correspondence Address
Please send complete application to:
Registrar
Admission Unit, Postcode

Open University Malaysia City/Town


METEOR HOUSE
State Country
Jalan Tun Ismail,
50480 Kuala Lumpur, Tel No. House Office
Malaysia.
H/Phone Fax No.
*Incomplete application will not be processed.
E-mail Address
EMPLOYMENT BACKGROUND
Permanent Address Title of Job Position Held Name of Organisation/ Period
(Most recent first) Company (Months/Years)

Postcode

City/Town

State Country

Tel No. House Nationality

NRIC No. New Old

Passport No.
FINANCIAL SUPPORT
Expiry Date Date of Birth How do you plan to support your graduate studies?
Place of Birth Please Tick

Race Personal finance

Scholarship
Sex Male Female Marital Status Single Married

In case of emergency, please contact :

Correspondence Address PROFICIENCY IN ENGLISH LANGUAGE


Please tick the appropriate box
Excellent Very Good Good Satisfactory Weak
Postcode
Written Communication
City/Town Verbal Communication
State Country
Foreign Students are requested to submit their IELTS or TOEFL scores:
Tel No. House Office Name of Tests:............................................................................ Year Taken: ....................... Score: ......................
H/Phone
Please explain why you applied for the above graduate program? How can this program assist you in your career
development?
EDUCATION BACKGROUND
Diploma or Year
Name of University/College Specialisation
Degree Awarded Graduated

I hereby certify that the information provided in this application form is correct to the best of my knowledge

.................................................... .......................................
Signature of Applicant Date