Tuos01app

NO. SEMAKAN: 00

NO. ISU: 02

TARIKH KUAT KUASA: 03/01/2010

Please ensure that this form is completed and all the relevant documents

indicated in the checklist on page 5 are enclosed. Incomplete forms and/or

documents will not be processed.

PART A TO BE COMPLETED BY THE APPLICANT

I PERSONAL DETAILS

Full name:

First name

Please write your name according to I.C.

I.C./Passport no.:

Place of birth:

Sex (please tick): Male

Marital status (please tick):

Correspondence address:

Country:

Telephone no.:

Permanent address

(if different from correspondence address):

Country:

Telephone no.:

PEJABAT TIMBALAN NAIB CANSELOR

(AKADEMIK & ANTARABANGSA)

Kod Dokumen:

APPLICATION FOR JOINTLY AWARDED

Please ensure that this form is completed and all the relevant documents

indicated in the checklist on page 5 are enclosed. Incomplete forms and/or

TO BE COMPLETED BY THE APPLICANT

Middle name Last name

ite your name according to I.C./passport

Date of birth:

Nationality:

Male Female

Single Married Others

Post Code:

Fax no.: E-mail address:

(if different from correspondence address):

Post Code:

Fax no.: E-mail address:

PERKHIDMATAN UTAMA

SISWAZAH

PEJABAT TIMBALAN NAIB CANSELOR

(AKADEMIK & ANTARABANGSA)

Kod Dokumen: PU/S/BR01/TUOS-01

APPLICATION FOR JOINTLY AWARDED

PhD DEGREE PROGRAMME

Please

1/6

Others

Please affix a recent Photograph

(COMPULSORY)

NO. SEMAKAN: 00

NO. ISU: 02

TARIKH KUAT KUASA: 03/01/2010 2/6

II EDUCATIONAL BACKGROUND

Name of university/college Degree

awarded

Year

CGPA

Specialisation Admission Graduation

III WORKING EXPERIENCE

Position held Name and address of employer Date

From To

Other relevant qualifications - Job Description

IV NEXT-OF-KIN

Name: Relationship:

Permanent address:

Country:

Post Code:

Telephone no.: Fax no.: E-mail address:

NO. SEMAKAN: 00

NO. ISU: 02


V DETAILS OF PROGRAMME APPLIED FOR

Universiti Putra Malaysia The University of Sheffield

Faculty/Institute:

Faculty/Institute:

Field of study:

Field of study:

Provide the name of potential advisor/supervisor if already identified:

Preferred semester for enrolment (please tick): First Second

Year: * Note:

For programme with thesis, please attach your research proposal (type-written, approximately

300 words) to include title, problem identification, objectives, methodology, significant

contribution to new knowledge and proposed schedule of work.

VI FINANCIAL SUPPORT

Please tick the relevant financial support. Enclose a photocopy of the document(s).

Scholarship

Bank loan

Self-financed - Certified photocopy of statement of bank account/Letter of financial

guarantee – for international applicants)

Others (please specify):

NO. SEMAKAN: 00

NO. ISU: 02


VII ENGLISH LANGUAGE PROFICIENCY

Please complete the information below (where relevant) and provide a copy of the results:

EXAMINATION SCORE / GRADE

TOEFL

IELTS

Note:

English Language Proficiency for international applicants – TOEFL (550) / IELTS (Band 6)

If you have previously been admitted to Universiti Putra Malaysia or other universities/institutions for

postgraduate programme, please provide the following information:

Name of university/institution

Date Reasons for withdrawal

Admission Withdrawal

VIII CERTIFICATION

I certify that the information given in this application is true. If the information is found untrue, UPM

has the right to reject the application/withdraw the offer of admission.

Signature of applicant: Date:

NO. SEMAKAN: 00

NO. ISU: 02


IX CHECK LIST FOR APPLICANT

Please enclose the following items in order to expedite the process. Please tick [/].

For Malaysian applicants:

Completed application form PU/S/BR01/TUOS-01 – two copies.

Report from two referees – PU/S/BR01/TUOS-01 (Attachment)

(in sealed envelope and with signature across it).

Certified copy of first and masters degree

certificate(s) – two copies.

Certified copy of examination transcript(s) – two copies.

Certified copy of degree certificate(s) – two

copies.


Research proposal [for programme with thesis] – two copies.

Certified copy of Identity Card – two copies.

Certified copy of letter of scholarship/sponsorship award (if any) or pay slip of applicant/guardian – two

copies.

For international applicants:

Completed application form PU/S/BR01/TUOS-01 – two copies.

Report from two referees - PU/S/BR01/TUOS-01 (Attachment) (in sealed envelope and with signature across it).

Certified copy of first and masters degree

certificate(s) – two copies.


Certified copy of degree certificate(s) – two

copies.


Certified copy of TOEFL/IELTS result(s) – two copies

Research proposal (for programme with thesis) – two copies.

Certified copy of passport (pages with photograph, personal particulars, and validity for at least one year) – two

copies.

Passport-sized photograph – two copies.

Certified copy of letter of scholarship/sponsorship award (if any) – two copies.

OR

Certified copy of statement of bank account/Letter of financial guarantee – two copies.

NO. SEMAKAN : 00

NO. ISU : 02

TARIKH KUAT KUASA : 03/01/2010 6 drp. 6

All completed applications must be sent to:

Dean, School of Graduate Studies

Zone 4, Off Jalan Stadium

Universiti Putra Malaysia

43400 UPM Serdang

Selangor Darul Ehsan, MALAYSIA

NOTE: Incomplete forms and/or documents will not be processed.

PART B FOR OFFICE USE

PU/S/BR01/TUOS-01 form – two copies.

PU/S/BR01/TUOS-01 (Attachment) – from two referees

Certified copy of first and masters degree Certified copy of examination transcript(s)

certificate(s) – two copies. – two copies.

Certified copy of degree certificate(s) Certified copy of examination transcript(s)

– two copies. – two copies.

Research proposal (for programme with thesis) – two copies.

Certified copy of Identity Card (for local applicant only) – two copies.

Certified copy of passport (for international applicant only) – two copies.

Passport-sized photograph – two copies.

Letter of scholarship/sponsorship award:

Checked by: Date:

Documents

Tuos01app