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					                                                                                              DYDW-01




                                                                                               Passport
                       YOUTH DEVELOPMENT STUDIES UNIT, DEPARTMENT OF PROFESSIONAL                Size
                      DEVELOPMENT AND CONTINUING EDUCATION, FACULTY OF EDUCATIONAL              Photo
                              STUDIES,43400 UPM SERDANG, SELANGOR, MALAYSIA

                                   APPLICATION FOR ADMISSION


Please ensure that this form is completed and all the relevant documents indicated in the
check list 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                   Middle name                 Last name

Malaysian – Please write your name according to I.C

I.C/Passport No. : ____________________________________ Date of birth_________________________________

Place of birth : ______________________________________ Race : ______________________________________
                                                                  (for Malaysian Only)

Sex (please tick):          Male        Female        Nationality : ______________________________________


Marital Status (please tick) :        Single          Married              Others

Correspondence address :
________________________________________________________________________________________________

________________________________________________________________________________________________

Country : _____________________________________ Post code : ________________________________________


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



Permanent address (if different form correspondence address) :
________________________________________________________________________________________________

________________________________________________________________________________________________

Country : ____________________________________        Post code : ________________________________________


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


UPM/YDSU/DYDW-01                                                                                          1/5
II    EDUCATIONAL BACKGROUND


        Name of                 Degree awarded                    Year                   Specialisation
University/College/School                             Admission          Graduation




III      Working Experience


Work Experience: ________ years

Duties/Tasks

                     Position held                      Name and Address of Employer   From        To




If space is inadequate, please attach appendix

Last salary:      RM ____________

Employer’s endorsement: Date__________ Name:______________________________             _________________
                                                                                       Signature & Stamp
Involvement in Youth/Social Work (please attach appendix)

Other relevant qualifications

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________


UPM/YDSU/DYDW-01                                                                                        2/5
IV       NEXT-OF-KIN

Name : ___________________________________________ Relationship : _________________________________

Permanent address : _______________________________________________________________________________

________________________________________________________________________________________________

Country : __________________________________ Post code : ___________________________________________


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



Please describe your language proficiency

         Language                                 Oral                                   Written

                              Excellent      Very Good        Good       Excellent    Very Good    Good

 Malay Language

 English Language

 Other Languages


V        DETAILS OF PROGRAMME APPLIED FOR

Field of study :   _________________________________________________________________________________

Faculty/Institute : _________________________________________________________________________________

Preferred semester for enrolment :             Mei            November


                                            Year : _____________________________


VI FINANCIAL INFORMATION

Profession wife/husband: ___________________________

Income wife/husband: RM __________________________

To participate in this programme I shall:

 Bear all the cost on my own

 Get sponsorship from my employer

 Get a scholarship

 Get a loan

 Other means (please indicate):



UPM/YDSU/DYDW-01                                                                                          3/5
VII       ENGLISH LANGUAGE PROFICIENCY

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

                     EXAMINATION                                                  SCORE/GRED

SPM (Malaysian only)

Others equivalent to SPM


VIII      ENDORSEMENT

      I hereby declare that all the information above is true and all certificates and examination results are valid. I
      understand that Universiti Putra Malaysia has the right to reject and cancel the offer or request me to leave the
      programme if any of the information, certificates and other documents are false.



      Signature of applicant : ______________________________          Date : _____________________




UPM/YDSU/DYDW-01                                                                                                   4/5
Name of Organisation   Position/   Role/Task/Experience   Certificate   Certified by KBS, JBS, Head of Department/ Organization) (Date &
                       Duration                                         Signature)




UPM/YDSU/DYDW-01                                                                                                                           5/5
IX       CHECK LIST FOR APPLICANT


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


For Malaysian applicants

1

     Completed application form DYDW-01 – two copies

2

     Passport size photograph – two copies

3

     Certified photocopy of identity card – two copies

4

     Certified copy of Certificate/Examinations Results - two copies

5

     Application processing fee RM 25.00, payble to the Bursar, UPM

6

     Copy of document on involvement in youth/social work – two copies

7

     Certificate/Score on English Test – two copies

8

     Document on sponsorship – two copies
For International Applicants

1

    Completed application form DYDW- 01 – two copies

2

    Passport sized photograph – three copies

3

    Certified photocopy of passport (pages with photograph, personal particulars and validity for at least one
    Year) – three copies

4

    Processing fee, payble to the Bursar, UPM : USD25 (for those who apply from outside Malaysia (if any)-
    two copies


5

    Certified photocopy of letter of scholarship/sponsorship award (if any) – two copies
GUIDE TO FILL IN THE APPLICATION FORM

REMINDER

○    Read the instructions carefully before filling in the form
○    The application will not be considered if the form is in complete
○    Use ball point pen

A. APPLICANT’S INFORMATION

1. Full name - Fill in the name as in the identity card in CAPITAL LETTERS. Use one letter
   for one box and leave empty between two words.

2. Identity card number (new and old) - fill in the number from the left. For the old IC number,
   the first box is for    the letter (A, S etc.) and followed by the numbers.

3. Sex - Please tick the appropriate space

4.   Race - Please indicate your race using the following code:

     Code    Race                          Code      Race
     M       Malay                         C         Chinese
     I       Indian                        H         Bumiputera Sabah
     K       Bumiputera Sarawak            A         Orang Asli Semenanjung
     L       Others

5.   Religion - Please indicate your religion using the following code:

     Code    Religion
     I       Islam
     B       Buddha
     H       Hindu
     K       Christian
     L       Others

6. Marital status -Please tick the appropriate space

7. Nationality
    Code Nationality                     Code        Nationality
    M        Malaysia                    S           Singapura
    P        Penduduk Maustautin         B           Brunei
    I        Indonesia                   L           Others

8. Profession    :       Indicate your present job

9. Date of birth - Please indicate your date of birth by day/month/year
10. Place of birth - Indicate which state were you born

    Code     State                      Code      State
    A        Perak                      N Negeri Sembilan
    B        Selangor                   P Pulau Pinang
    C        Pahang                     R Perlis
    D        Kelantan                   S Singapura
    E        Thailand                   T Terengganu
    I        Indonesia                  V W.P. Labuan
    J        Johor                      W Kuala Lumpur
    K        Kedah                      X Sabah
    Y        Sarawak                    U Brunei
    M        Melaka                     L Others

11. Handicaps - Please indicate if you have any physical defects

12. Internet - If you are accessible to internet facilities

13. E-mail - Please write your e-mail address

14 and 15. Mailing address - Please indicate your home and/or office address


ACADEMIC INFORMATION

16. SPM/SPVM/MCE results - Please indicate the examination taken, year, stream (art or science
    etc), aggregates and grade for each subject taken. Please attach a certified copy of the
    results..

17 STPM/STP/HSC - Please indicate the examination taken, year, stream (art or science etc),
   aggregates and grade for each subject taken. Please attach a certified copy of the results.

18. Please indicate the name of the institute of higher learning you have attended, year of
    graduation, program (certificate/diploma/bacelor), specialization (if any) and the examination
    results. Please attach a certified copy.

19. Please indicate your language proficiency


CAREER INFORMATION

20. Working experience -Please indicate the years of experience

21. Indicate the task/duty

22. Your last pay

23. Get the signature and stamp of your employer.

24. Indicate your involvement in youth/social work. Please attach a certified copy. Get it
    endorsed by the organisation.
FINANCIAL

25. Please indicate your wife/husband’s present job

26. Indicate your wife/husband’s latest salary amount

27. Please tick (X) in the appropriate box


CHECKLIST

Please tick (X) in the appropriate boxes

a. Signed the application form
b. Passport size photo
c. A certified copy of identity card
d. Ceritified copies of examination results
e. Reply form (with stamp)
f. Processing fee of RM 25.00 (receipt no.)


F. ENDORSEMENT

Please read carefully. Write the date and sign the form.

Please return the completed application form before or on the closing date (as advertised) to the
following address:

        Youth Development Studies Unit
        Department of Professional Development and Continuing Education
        Faculty of Educational Studies
        Universiti Putra Malaysia
        43400 UPM, Serdang Selangor.

        Tel : 603-89468239 / 603-89468229
        Fax : 603-89450455

				
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