o Swinburne University Sarawak Campus

Representative/agent stamp
Swinburne University of Technology
International Education Centre (IEC)
Sarawak Campus
Ground Floor, Centro House, Nairobi, Kenya
(if applicable)
T: +254 20 444 87 42 / 444 95 36 /444 65 00
Application Form for Admission
E: [email protected]
SECTION A: PERSONAL DETAILS
If previously enrolled at Swinburne University of Technology, please state ID number
(Swinburne ID number)
PRINT YOUR NAME AS IT APPEARS IN YOUR NRIC/PASSPORT. Please use BLOCK LETTERS. All fields must be completed.
Title:
(Mrs, Miss, Ms, Mr etc)
Gender:
Female
Male
Date of birth:
/
Day
/
Month
Year
Family name:
(as indicated in NRIC/passport)
International Education Centre (IEC)
Given names:
(leave spaces between names)
Ground Floor, Centro House, Nairobi, Kenya
T: +254 20 444 87 42 / 444 95 36 /444 65 00
E: [email protected]
Email address:
(for applicant)
APPLICANTS MUST PROVIDE THEIR PERSONAL EMAIL ADDRESS. ALL INFORMATION REGARDING THE
PROGRESS OF THE APPLICATION WILL BE EMAILED DIRECTLY TO THE APPLICANT OR SWINBURNE
SARAWAK REPRESENTATIVE.
Postal address:
Number/street
State/town/city
Country
Postcode
application
Residential address:
(if different from above and
should not be the same as
your agent)
Number/street
State/town/city
Country
Postcode
Fax:
Telephone:
Mobile:
Do you have any medical condition that requires the attention of the university?
Yes
No
Note: this is for support purposes only and will not affect the outcome of your application.
If yes, please provide details:
Have you been granted a scholarship/loan of any kind?
Yes
No
Scholarship name:
eg. Yayasan Sarawak Scholarship Loans, PTPTN, Higher Education Fund, Yayasan Tunku Abdul Rahman, etc.
Country of citizenship:
Submission location:
(What country were you in when you submitted this application?)
Country of birth:
Identity Card (IC)
(for Malaysian students only)
Race:
Religion:
or Passport number:
(for International students only)
Passport expiry date:
/
Day
/
Month
Year
FOR INTERNATIONAL STUDENTS ONLY
Do you hold a valid Malaysian visa?
If yes, type of visa:
Yes
No
Visa expiry date:
/
Day
/
Month
Year
SECTION B: COURSE PREFERENCES
Course preference
Intake
Year
eg. Bachelor of Business
February
2008
1
2
3
International Education Centre (IEC)
Ground Floor, Centro House, Nairobi, Kenya
T: +254 20 444 87 42 / 444 95 36 /444 65 00
E: [email protected]