International Islamic University Malaysia

Transcription

Admission Booklet
For International Undergraduate
Programme 2011/2012
INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA
ADMISSIONS & RECORDS DIVISION, IIUM, JALAN GOMBAK, 53100 KUALA LUMPUR
Tel: 603-6196 4045 / 4043 / 3024 / 3261
Fax: 603-6196 4724 / 4160
E-Mail: [email protected]
Website: hp://www.iium.edu.my/anr
INTERNATIONALISLAMIC
ISLAMICUNIVERSITY
UNIVERSITYMALAYSIA
MALAYSIA
INTERNATIONAL
Admission Checklist
Students
No.
Particular
Page
1.
Offer Leer
2.
Admission Booklet
3-8
3.
Order of Aire for Students
9-12
4.
Student Discipline Rules
5.
Appendix A
Please refer to:
www.iiu.edu.my/rector/legal/
13-15
TUITION FEE AND OTHER RELATED ADMINISTRATIVE FEES
6.
Appendix B
16-18
TERMS AND CONDITIONS OF OFFER AND ENROLMENT
7.
Appendix C
19-29
ALL RELATED FORMS
* Admissions & Records Division
March 2011
Admissions & Records Division
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ISLAMICUNIVERSITY
UNIVERSITYMALAYSIA
MALAYSIA
INTERNATIONAL
Admission Booklet Contents
Students
1.
Welcoming Message
A NOTE FROM THE DEAN OF ADMISSIONS AND RECORDS DIVISION
2.
Enrolment Guidelines
3.
* Acceptance/Deferment/Rejection Form
4.
* Financial Declaration Form
5.
** Health Examination Report For
International Student
6.
***Mahallah Registration Form
( L A S T U P D AT E : M a r c h 2 0 1 1 )
On enrolment day,
* These forms are to be submied to the counter of Pre-Registraon and Submission
** This form is to be submied to the counter of Health Centre
*** This form is to be submied to the counter Mahallah
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A Note From The Dean of
ADMISSIO NS A ND RE C ORDS DI VI S I ON
I am so pleased to welcome you to the International Islamic University Malaysia. I would
also like to take this opportunity to congratulate you on geing a place at the University. I
can assure you that we have an exciting educational program awaiting you. I trust you will
find your time have rewarding and complimentary to your personal and professional goals.
At IIUM, we are blessed with beautiful surroundings. I am sure you will enjoy the beauty
of our campus and appreciate the opportunity to study at the great university. The
state-of-the-art program will equip you with the skills you need to gain control over your
own destiny.
Over the years, the University has built a strong reputation as one of the leading Universities in the Islamic world. We achieved this by exercising a tradition that fosters excellence
and unity in diversity.
We are delighted that you have selected the International Islamic University Malaysia. We
look forward to greeting you in person.
Dean
Admissions and Records Division
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Enrolment Guidelines
F OR N EW U NDE RG RA DU AT E S T U DE NT S
1.
2.
CONGRATULATIONS for being selected to join the International Islamic
University Malaysia (IIUM).
1.1
All the information provided is to prepare you for enrolment at the Main
Campus, International Islamic University Malaysia, Gombak, Selangor
Darul Ehsan.
1.2
Please read carefully and follow the instructions given.
ACCEPTANCE / DEFERMENT / REJECTION
If you accept or reject our offer, you should: 2.1
Fill in the Reply Form (IIUM-R1) enclosed together with the offer leer and a
copy of your payment slip transaction through mail/e-mail/fax.
2.2
Fill in all the relevant documents/forms (to be submied on the Enrolment
Day).
If you defer our offer: 2.3
3.
Submit the Reply Form (IIUM-R2) together with the offer leer to our
University by stating that you have to defer your study or rejected our offer
through mail/e-mail/fax. Note: No further application will be entertained
once you have rejected the offer.
ATTIRE DURING ENROLMENT AND ORIENTATION WEEK
MALE
3.1
3.2
3.3
Long sleeve shirt. All round boom shirts must be tucked in.
Dark coloured trousers.
Dark coloured shoes.
FEMALE
3.4 Wear ‘Mini telekong’ or head gear.
3.5 National dress or dress which covers the aurah.
3.6 White ‘Long skirt’ for special occasion (Orientation Week)
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You are required to bring along the original documents / items of the following on
the Enrolment Day: -
4.
1.
Identity Card and Birth Certificate (for Malaysian students only).
2.
Birth Certificate or Passport (for International students only).
3.
School leaving certificate (for Malaysian undergraduate students).
4.
SPM / ‘O’ Level certificate and STPM / ‘A’ Level certificate or their equivalent.
5.
Five recent photographs of yourself measuring 3 cm x 3.5 cm with your
name, matric number, programme offered to you wrien at the back of every
photograph. Bring them along during enrolment.
Note: a.
You are required to submit your photographs to the following Unit / Divisions: 1.
Student Affairs & Development Div.
2 photos
2.
Residence (Mahallah)
(to be submied at the respective Mahallah Office)
1 photo
3.
2 photos
5 photos
b.
Medical Check-up form and X-ray
i.
All new students are required to do a medical check-up at the IIUM Health
Centre (except the IIUM Matriculation students). Please refer to Appendix
B on the health requirements for International students.
ii.
In addition, you are also required to bring an X-ray film on that day. In case
you cannot bring your X-ray, it can be done at the IIUM Health Centre.
iii.
Please fill-in only Part 1 and 2 of the IIUM Medical Form (IIUM6-M). The
remaining parts will be filled by our Medical Officer.
iv.
The above directive must be observed. For any assistance, you can contact
IIUM Health Centre upon your arrival in campus.
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IIUM Dress Code
DRESS CO DE F OR MU S L I M F E MA L E S T U DE NT S
1.
2.
3.
GENERAL FEATURES
1.1
The aire should cover the whole body except the face and palms (for
sisters).
1.2
The aire to be worn should not be tight-fiing
1.3
Sarongs or skirts without slits may be worn if they are loose and long
enough to reach and cover the ankles.
1.4
Women’s aire must not resemble that of man’s.
PANTS
2.1
Pants should not be figure-hugging, cover the ankles, tailored and loose.
2.2
Pants may be worn with a long, loose upper dress covering the hips,
reaching as well as covering the knee and without slits.
BLOUSE
3.1
4.
HEAD-COVER
4.1
5.
The headgear should cover the head, neck, chest and shoulder.
MATERIAL
5.1
6.
A long loose-fiing blouse, high-collared or high-necked with long sleeves
reaching the wrists may be worn.
Dress materials should not be transparent and revealing.
FOOTWEAR
6.1
Footwear should cover the feet, and the heels of the footwear should not be
excessively high i.e not more than 3 inches.
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IIUM Dress Code
DRESS CODE FOR MUSLIM MALE STUDENTS
1.
The aire must cover the ‘aurah’ of the male body.
2.
i.
Students should not wear slippers, round-neck T-Shirts, tight-fiing
trousers or pants during office hours, lectures, tutorials, formal indoor
University functions and other formal activities.
ii.
Jeans are not encouraged but if they are to be worn by the students they
should not be tight fiing, multi-coloured, faded, fancy in design, torn or
with patches.
3.
Shirts of unusual fashion should not be worn.
4.
Neck and wrist chains should not be worn except for medicinal purposes or on
religious grounds.
5.
The length of the hair should not extend beyond the collar and the hairstyle
should not be of unusual or extraordinary fashion.
6.
National dress/aire may be worn provided they do not violate or infringe the
dress code.
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Orders of Aire
F OR S T U DE NT S
1.
GENERAL ORDERS
1.1
All Students are required to display on their upper dress/shirt their
respective Students’ Identity cards at all material times whilst in University’s
premises except when aending sports activities.
An offence under this Order is a compoundable offence and shall be dealt
with in accordance with the procedure in Rule 34 of the Students’ Discipline
Rules.
1.2
Students are not allowed to wear any aire or accessory, which symbolize
any particular external organization or group except on certain proper
occasions and with the permission from the University authorities. Students’
aires must not display any provocative or detrimental designs, images,
words or phrases that may seem to be against the University Dress Code.
1.3
Jeans are not allowed to be worn except on non-formal occasions and during
physical activities such as sports or recreation, provided they are not
tight-fiing, multicoloured, faded, fancy in design, torn or with patches.
Rules.
1.4
National dresses/aires may be worn provided that they do not violate or
infringe the University’s requirements and Islamic values and norms.
1.5
Vanity or ostentation should not be a motive in puing on of any dress or
aire.
1.6
The aire of men shall not resemble that of the women’s and vice versa.
Rules.
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2.0
ORDERS OF ATTIRE FOR FEMALE STUDENTS
2.1
General Features
For an example of the approved aire, refer to the illustrations in Appendix ‘A’.
2.1.1
As far as a female Muslim student is concerned, her aire must cover the
aurah (as provided under the Shariah). Save for the face and the palm the
aire should cover the whole body. Any form of clothing that covers the
face is prohibited.
An offence under this Order is a Compoundable Offence and shall be dealt with in
accordance with the procedure in Rule 34 of the Students’ Discipline Rules.
2.1.2
Aires shall not be tight fiing.
An offence under this Order is a compoundable offence and shall be dealt with in
2.1.3
The aire should be made from such material such that the colour of the
skin and shape of the body would not be visible. Dress materials should
not be transparent or reveal the contour of the body.
2.1.4
Sarongs and skirts without slits may be worn if they are loose and must be
long enough to reach and cover the ankles. Skirts which are tight or which
does not cover the ankles are not allowed.
2.1.5
Excessive accessories, strong perfumes and facial make-ups are not allowed.
2.2
Pants
2.2.1
Pants should not be tight fiing or figure hugging; they should be loose and
cover the ankles.
2.2.2
Pants should be worn only with a long, loose upper dress, which covers the
hip. The upper dress should not have long slits or side cuts, which reveal
the hip or thigh area.
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2.3
Blouse
2.3.1
A loose-fiing blouse and upper dress may be worn provided they have
long sleeves reaching the wrists and covering the hips as well.
An offence under this Order is a Compoundable Offence and shall be dealt with in
2.4
Head-cover
2.4.1
For female Muslim students, the head-cover should properly cover the
head and should not reveal the hair, neck, chest and shoulders.
2.4.2
As for female Non-Muslim students, she may adopt Islamic dress, if she
so desires. Otherwise she should at least cover the head with a scarf or
shawl or similar headgear as a symbol of respect to the Islamic
University. For an example of the approve aire refer to the illustrations
in Appendix ‘A’.
An offence under this Order is a compoundable offence and shall be
dealt with in accordance with the procedure in Rule 34 of the Students’
Discipline Rules.
Save as for convocation, the ceremonial aire for graduands, shall be
such as determined by the University from time to time.
2.5
Hair
2.5.1
As far as possible, students should avoid unnecessary dyeing or
colouring of hair.
An offence under this Order is a Compoundable Offence and shall be dealt
with in accordance with the procedure in Rule 34 of the Students’
Discipline Rules.
2.6
Footwear
2.6.1
Footwear should cover the feet, and the heels of the footwear should not be
excessively high. Slippers are forbidden.
An offence under this rule is a compoundable offence and shall be dealt with in
accordance with the Rule 34 herein.
3.0
ORDERS OF ATTIRE FOR MALE STUDENTS
For a beer perspective of the sample of approved aire, students shall refer to the
illustrations in Appendix ‘A’.
3.1
The aire of the male Muslim students must cover the aurah (as provided
under the Shariah) of the male body.
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3.2
Slippers, non-strip sandals, round neck T-shirts, tight-fiing trousers or
pants should not be worn by students during lectures, tutorials, official
University functions and other formal activities as well as within the proximity of the IIUM administrative and faculty buildings and centres. In all
the above occasions, jeans are absolutely not allowed.
3.3
Shirts and collared T-shirts are allowed to be worn when aending classes.
Except for bush jackets, properly-buoned Baju Melayu, batik shirts and
other proper national suits, the shirts and collared T-shirts should be
tucked in the trousers at all material times.
3.4
T-shirts of all kinds are not allowed to be worn during formal University
functions and other formal activities unless expressly allowed by the
authorities for certain specific functions.
3.5
Neck and wrist chains should not be worn except for medical purposes or
on religious and/or traditional grounds.
3.6
The length of the hair should not extend beyond the collar and the hairstyle should not be of unusual or extraordinary. Unnecessary dyeing or
colouring of hair is prohibited.
3.7
The areas of the body between the navel and the knee shall be covered in
public at all times including in the halls of residence (Mahallah) and all
public premises, except under permissible circumstances such as
sporting events.
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APPENDIX A
ISLAMICUNIVERSITY
UNIVERSITYMALAYSIA
MALAYSIA
INTERNATIONAL
Tuition Fee and Other Related Administrative Fees
F OR IN TERN AT I ONA L U NDE RGRA DU AT E
1.
You will only be officially enrolled as a student of IIUM upon payment of the
following fees:
a. Entrance Fees
b. Semester Fees (Tuition Fee, Recurrent Academic Fees, Hostel Fee)
c. Personal Bond
2.
Self-financed students must provide the evidence in the Guarantee Leer form or
Bank Statements or Statutory Declaration that you have sufficient funds to cover
all expenses throughout your studies. You should allocate sufficient funds for
food, clothing, books, incidental expenses and necessary travel fare to and from
the University.
3.
Payments* can be made in the following forms:
a. Bank Dra (Account No: 1407-0000005-71-9 (UIAM STUDENT))
b. Telegraphic Transfer (T & T) (SWIFT CODE: BMMBMYKL)
c. Credit Card (at hp://epayment.iiu.edu.my/eregister)
The payment should be made payable to:
Finance Director International Islamic University Malaysia
Or into the following bank account:
Bank Muamalat (M) Berhad
IIUM Branch, Gombak
53100 Kuala Lumpur, Malaysia
* Payments can be made in the following currencies: USD$, £ or Euro € currencies
(equivalent to the Ringgit Malaysia RM amount)
4.
Sponsored students will not be enrolled unless they submit the original leer of
offer from the sponsoring agency.
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APPENDIX A
INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA (IIUM)
5.
E NTRAN CE FEES
ENTRANCE FEES
(ONCE IN DURATION OF STUDY)
Orientation
120.00
120.00
Alumni
100.00
100.00
Registration
30.00
30.00
Student Identification card
60.00
60.00
College Deposit (Refundable)
-
-
University Caution money (Refundable)
-
-
Medical check-up
-
50.00*/75.00**
English and Arabic Placement Test
-
200.00
310.00
560.00*/585.00**
TOTAL ENTRANCE FEES
* X-ray done outside the University.
6.
International
Direct
RM
International
Ex-Matriculation***
RM
** X-ray is carried out by the University’s Clinic.
K ULLIY YAH / PRO GRAMME F E E S
(PER SEMESTER-EXCLUDING SHORT SEMESTER)
Undergraduate
Programme –
International
Pre-Sessional
Laws
Economics
Islamic Revealed
Knowledge & Human
Sciences
Information Technology
Engineering
Architecture
Science
-BSMS
Medicine
Dentistry
Pharmacy
Nursing
Allied Health Science
Tuition
Fee
(RM)
Recurrent Hostel
Academic Fees**
(RM)
Fees*
(RM)
Total
(RM)
600.00
4,250.00
3,750.00
157.50
157.50
157.50
600.00
600.00
600.00
1,357.50
5,007.50
4,507.50
3,500.00
157.50
600.00
4,257.50
3,750.00
7,000.00
7,000.00
6,000.00
6,000.00
19,000.00
19,000.00
19,000.00
19,000.00
6,000.00
157.50
182.50
182.50
182.50
157.60
182.50
182.50
182.50
182.50
182.50
600.00
600.00
600.00
600.00
600.00
600.00
600.00
600.00
600.00
600.00
4,507.50
7,782.50
7,782.50
6,782.50
6,757.50
19,782.50
19,782.50
19,782.50
19,782.50
6,782.50
RECURRENT
ACADEMIC
FEES DETAILS*
(RM)
Examination
Library
Co-curricular
Activities &
Transport
College activities
Medical Facilities
Welfare fund
Insurance
Computer Fee
Laboratory / Studio
RELATED FEES
SCIENCE NON
SCIENCE
BASED
(RM)
(RM)
25.00
25.00
25.00
25.00
37.50
37.50
25.00
15.00
2.50
2.50
25.00
25.00
25.00
15.00
2.50
2.50
25.00
-
182.50
157.50
** For Usrah/Transit room the rate is RM500.00 per semester
* NOTES: The University has the right to revise the fees without noficaon.
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APPENDIX A
7.
P ERSON AL BO ND
All International students are required to pay a personal bond at the point of
enrolment, which is refundable upon completion of studies. The rate of the personal
bond varies by country as stipulated by the Malaysian Immigration Authority.
NO.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
COUNTRY
Africa
Australia
Bangladesh
British Commonwealth Independence
Brunei
Canada
China
Europe
German
Hong Kong
India
Indonesia
Iran/Iraq
Japan
Korea
Macau
Myanmar
Nepal
Pakistan
Philippines
Portugal Commonwealth Independence
Saudi Arabia
Singapore
Sri Lanka
Taiwan
Thailand
Tunisia
United Kingdom
USA
Vietnam
RATE (RM)
RATE (USD)
1,500.00
1,500.00
750.00
1,500.00
1,500.00
2,000.00
1,500.00
1,500.00
1,500.00
1,000.00
750.00
500.00
1,500.00
1,000.00
1,000.00
1,000.00
750.00
750.00
750.00
1,500.00
1,500.00
1,500.00
200.00
750.00
750.00
300.00
1,500.00
1,500.00
2,000.00
1,500.00
395.00
395.00
198.00
395.00
395.00
527.00
395.00
395.00
395.00
264.00
198.00
132.00
395.00
264.00
264.00
264.00
198.00
198.00
198.00
395.00
395.00
395.00
53.00
198.00
198.00
79.00
395.00
395.00
527.00
395.00
* Personal Bond of RM1, 500.00/USD395.00 is imposed on countries that are not listed above.
8.
Entrance Fee will not be refunded in the event the student withdraws from the
University.
9.
The Tuition Fee and Related Fees paid will be refunded as follows in the event of
withdrawal or study leave:
a. 90% refund – From first day up to first month.
b. 60% refund – From first month up to the second month.
c. No refund – Aer second month of semester.
10.
In the event a student made an overpayment, he or she can request for either a
refund or the amount to be set off against future semester charges.
11.
The University has the right to revise the fees without notification.
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A P P EN D I X B
Terms and Conditions of Offer and Enrolment
(FO R IN TERNAT I ONA L S T U DE NT S ONLY )
1.
ACCEPTANCE / REJECTION / DEFERMENT OF OFFER
i.
Your reply using IIUM-R1/ IIUM-R 2 forms should reach us by the stipulated
date as stated in the offer leer, otherwise this offer of admission will
automatically be revoked.
ii. Please be reminded that International students are not allowed to enter
Malaysia unless the Immigration Department of Malaysia has approved their
student pass. Therefore, please do not make any arrangements to come to the
university before you receive the leer of approval of your student pass from
our office. The university will not be responsible if you come to Malaysia
without the approval of your student pass and you will have to return to your
home country. The university will not provide any passage allowance for your
return or any extra allowance that you have to pay for the visa. All expenses
incurred must be borne by you.
You are also required to make the necessary traveling arrangements to Kuala
Lumpur, Malaysia. International students must ensure that your International
passport has a validity period of at least two (2) years.
iii. For further information, you can contact the university’s officers in the
following ways: Telephone number:
Extension:
Fax number:
603-6196 4000 /4045 /4043
3022 OR 3024
603-6196 4724
EMail address:
[email protected]
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2.
APPENDIX B
HEALTH REQUIREMENTS (for international students only)
No cholera or smallpox vaccination certificate is required to be provided in order
to enter Malaysia. However, yellow fever vaccination is required from residents of
South America and Africa (except South Africa). The health regulations of the
country require those arriving from the above-specified regions without the valid
immunization certificate or before the inoculation period, to be immediately
quarantined for six days.
Please be informed that you are required to undergo a Medical
Examination/Check-up in your respective country at the authorized government
hospital. The Medical Examination/ Check-up report must be presented to the
IIUM Health Centre during the medical check-up exercise conducted during the
orientation (Ta’aruf) week. However, all international students are required to
undergo a second screening at IIUM Health Centre upon enrolment prior or
during the orientation (Ta’aruf).
The university health requirement stipulates that the students who wish to
enroll into the university must be free of HIV/AIDS and drug addiction. As
such, you are required to undergo urine and blood tests at your home country.
The university has the right to ho can be contacted during emergency revoke the
admission of a student if he/she is found to be affected by the said disease or is
found positive for drug addiction.
3.
ADVICE FOR MARRIED APPLICANTS
If you are married, you are advised to come alone to the university to undergo the
process of enrolment and course registration. Please be reminded that the
University will not be responsible for any maers pertaining to Immigration (such
as visa for your spouse or/and children) and will not provide any assistance if you
run short of funds.
4.
ENGLISH PROFICIENCY TEST (EPT)
All new students are required to sit for the EPT. However, an exem if you can present a score of 550 paper-based or 213 computer-based in the Test of English as a
Foreign Language (TOEFL) or overall Band 6.0 in the test administered by the
British Council (IELTS). The EPT test will be conducted during the first week of the
orientation programme. If you do not fulfill the English language proficiency
requirements (for programmes that use English as a medium of instruction), you are
required to undergo the Pre-sessional Programme (PRSS) before proceeding to the
respective programme of studies and pay the tuition and academic administrative
fees while in the programme [please refer to Appendix A]. The maximum duration of
Pre-sessional Programme (PRSS) is two (2) years.
Please refer to the aached brochure on the EPT requirements.
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5.
APPENDIX B
ARABIC PLACEMENT TEST (APT)
All new students are required to sit for the APT. The test will be conducted during
the first week of the orientation programme. Those who do not fulfill the Arabic
language proficiency requirements (for Arabic Language & Literature and Islamic
Revealed Knowledge & Heritage programmes) are required to do Pre-sessional
Programme (PRSS) before proceeding to the respective programme of studies that
use Arabic as its medium of instruction. The maximum duration of the
Pre-sessional Programme (PRSS) depends on the respective Kulliyyah
requirement. The students are also required to pay the tuition and academic
administrative fees while in the programme [Please refer to Appendix A].
6.
TILAWAH PLACEMENT TEST (TPT)
All new students are required to sit for the TPT to determine their level of
recitation and understanding of the Taj’wid. There are two (2) levels that students
have to fulfill as their graduation requirements. The test will be conducted during
the first week of the orientation programme. Those who are exempted from the
first level may proceed to the second level.
7.
TA’ARUF (ORIENTATION) PROGRAMME (compulsory to all new students)
All students are required to aend Ta'aruf (Orientation Programme) conducted by
the university and participate in all the programmes organised by various bodies
of the university.
8.
CODE OF CONDUCT
Students of the International Islamic University Malaysia are expected to observe
Islamic behavioral norms at all times on or off campus.
9.
DRESS CODE
Please refer to “Discipline of Student Rules 1984 [Amendment (2002)]” handbook
for more details.
IMPORTANT NOTE:
NO STUDENT WILL BE ALLOWED TO ENROL WITHOUT THE ORIGINAL
ACADEMIC DOCUMENTS ON THE ENROLMENT DAY. IF THE UNIVERSITY
AUTHORITIES DISCOVER ANY FALSE DECLARATION AND THE USE OF
FORGED CERTIFICATES AND DOCUMENTS BY ANY STUDENT TO GAIN ENTRY
INTO THE UNIVERSITY BEFORE OR AFTER THE ENROLMENT, THIS OFFER OF
ADMISSION WILL BE REVOKED. THE UNIVERSITY MAY AT ITS ABSOLUTE
DISCRETION TAKE OR CAUSE ANY LEGAL ACTION TO BE TAKEN AGAINST
ANY STUDENT GUILTY OF COMMITTING FORGERY OR FRAUD.
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APPENDIX C
IIUM2-D
F I N A N C I A L D EC LAR ATIO N FO R M
(Please fill up this form)
NAME:
MATRIC NO.:
PROGRAMME:
1.
I agree herewith and promise to pay all the fees as required by the University.
2.
I agree that the University has the right to deduct from my scholarship or financial
aid given to me to sele the payments mentioned above.
3.
I agree that the University has the right to demand the above payments from my
guarantor if I leave the University without seling them.
4.
I agree that the University has the right to revise the fees without any notification.
5.
I fully understand and accept all other conditions as stated in the OFFER LETTER,
ADMISSION BOOKLET AND APPENDICES.
Signature of student: …………………………………………
Date: ……………………
Admission Booklet
Pag e
19
APPENDIX C
Health Examination Guidelines
F OR F OR E NT RY I NT O
MALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS
1.
PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE
FORM.
2.
PLEASE FILL IN THE FORM IN ENGLISH LANGUAGE.
3.
PLEASE WRITE IN CAPITAL LETTERS.
4.
THIS FORM HAS 4 SECTIONS:
(a)
SECTION 1 (PART A AND B) TO BE FILLED BY THE CANDIDATES; AND
(b)
SECTION 2, 3 AND 4 TO BE FILLED BY THE EXAMINING DOCTOR
5.
PLEASE COMPLETE ALL THE TESTS REQUIRED IN THIS FORM.
6.
THE UNIVERSITY / COLLEGE ONLY ACCEPTS MEDICAL EXAMINATION
DONE WITHIN 60 DAYS BEFORE REGISTRATION OR WITHIN 30 DAYS
AFTER REGISTRATION.
7.
PLEASE ATTACH ALL THE ORIGINAL LABORATORY RESULTS.
8.
PLEASE
BRING ALONG CHEST X-RAY
REGISTRATION.
9.
PLEASE ENSURE THE X-RAY FILM IS LABELLED WITH YOUR NAME AND
DATE TAKEN (IN ENGLISH).
10.
CHEST X-RAY DONE WITHIN 6 MONTHS PRIOR TO REGISTRATION CAN
BE ACCEPTED.
11.
THE UNIVERSITY / COLLEGE RESERVES THE RIGHT TO REPEAT FULL
MEDICAL CHECK-UP OR ANY SPECIFIC LABORATORY TESTS SHOULD
THERE BE ANY DOUBT IN THE MEDICAL REPORT SUBMITTED. ALL COSTS
INVOLVED SHALL BE BORNE BY THE CANDIDATES.
12.
THE UNIVERSITY / COLLEGE RESERVES THE RIGHT TO REJECT ANY
APPLICATION:
FILM A ND REPORT
FOR
(a)
BASED ON THE RESULTS OF THE HEALTH EXAMINATION; OR
(b)
SHOULD THERE BE ANY EVIDENCE THAT THE APPLICANT HAS
GIVEN FALSE INFORMATION IN THE HEALTH EXAMINATION
REPORT OR ANY SUPPORTING DOCUMENTS.
Admission Booklet
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20
HEALTH EXAMINATION REPORT
FOR INTERNATIONAL STUDENT
Passport size
photo
PLEASE USE CAPITAL LETTERS
SECTION 1 (To be completed by candidate)
(PART A)
FULL NAME (As in passport)
INTERNATIONAL PASSPORT NO.
NATIONALITY
DATE OF BIRTH
CONTACT NUMBER
AGE
D D M M Y Y
ACADEMIC YEAR
PROGRAMME OF STUDY
SEX
MALE
FEMALE
MARTIAL STATUS
SINGLE
MARRIED
STUDENT ID
PROGRAMME CODE
NEXT OF KIN
NEXT OF KIN’S ADDRESS
NEXT OF KIN’S CONTACT NUMBER
Admission Booklet
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21
SECTION 1 - Please tick () in the relevant box
(PART B)
Declaration of self and family illness. Explain in full if you or your family has any of the following illnesses.
* Immediate family refers to father, mother, brothers / sisters
MEDICAL PROBLEMS
1.
Congenital or inherited disorder
2.
Allergy
3.
Mental illness
4.
Fits, stroke, other neurological
disease
5.
Diabetes Mellitus
6.
Hypertension
7.
Heart or vascular disease
8.
Asthma
9.
Thyroid disease
SELF
Yes
No
IMMEDIATE
FAMILY
Yes
No
If “Yes” please state.
10. Kidney disease
11. Cancer
12. Tuberculosis
13. Drug addiction
14. AIDS, HIV
15. History of surgery
16. Other illnesses
Current medication (Long term)
IMMUNIZATION HISTORY
(where applicable)
1.
Yellow Fear
2.
BCG
3.
Meningitis (Quadrivalent)
4.
Hepatitis B
5:
Others:
DATE IMMUNIZED
I hereby certify that the information given above is true. I understand that my application will be rejected if there
is any false information given.
......................................
Date
....................................................
Signature of candidate
Admission Booklet
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22
SECTION 2 - PHYSICAL EXAMINATION
(To be filled by examining doctor)
1. BASIC MEASUREMENT
HEIGHT : __________________ m
BLOOD PRESSURE : ______________ mmHg
WEIGHT : __________________ kg
PULSE RATE
VISION TEST : Unaided : (R) _______ (L) ________
COLOUR VISION TEST :
Aided
: (R) _______ (L) ________
: ______________ / min
NORMAL
/
ABNORMAL
2. GENERAL EXAMINATION
ITEM
YES
NO
COMMENT
a. DEFORMITIES
b. PALLOR
c. CYANOSIS
d. JAUNDICE
e. OEDEMA
f. SKIN DISEASES
3. SYSTEMIC EXAMINATION
ITEM
NORMAL
ABNORMAL
COMMENT
a. EYES (including funduscopy)
b. EARS
c. NOSE
d. ORAL CAVITY / THROAT
e. NECK
f. HEART
g. LUNGS
h. ABDOMEN / HERNIA ORIFICES
i. NERVOUS SYSTEM
j. MENTAL CONDITION
k. MUSCULOSKELETAL SYSTEM
Admission Booklet
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23
SECTION 3 - INVESTIGATIONS
URINE TEST
ITEM
DATE TAKEN
RESULT
DATE TAKEN
RESULT
a. ALBUMIN
b. SUGAR
c.
MICROSCOPIC
d. MORPHINE
e. CANNABIS
f.
AMPHETAMINES TYPE
STIMULANT
BLOOD TEST
ITEM
a. HEPATITIS Bs ANTIGEN
b. HEPATITIS C
c.
HIV
d. VDRL / TPHA
e. MALARIAL PARASITE
CHEST X-RAY INFORMATION
CHEST X-RAY NO.
DATE TAKEN
PLACE TAKEN
REPORT
Admission Booklet
Pag e
24
SECTION 4 - CERTIFICATION BY THE EXAMINING DOCTOR
Please tick (
) in the appropriate box :
I certify that I have on this date ___________________ examined
Mr. / Ms. _______________________________________________________ ,
Passport No.: ______________________ and found him/her :-
IN GOOD HEALTH
HAVING THE FOLLOWING MEDICAL COMPLICATION(S) (Please State)
UNDERGOING TREATMENT FOR: (Please State)
Signature of Doctor / Date
Name of Doctor:
Qualification:
Hospital/Clinic:
Registration No.:
Official stamp:
Remarks By University Official :
Admission Booklet
Pag e
25
APPENDIX C
IIUM-R1
Dean
P.O. Box 10, 50728 Kuala Lumpur, Malaysia
Fax No: 603-61964724
ACC EP TA N C E / RE J E CTIO N FO R M
(Please fill up this form)
1.
Full Name: ………………………………………………………………………................
2.
Matric. No.: ………………………………………………………………………………...
3.
Programme: ………………………………………………………………………………...
Please tick (
) one of the followings:
I accept the offer of admission
I do not accept the offer of admission (Please note that no further appeal or
application will be entertained once you have rejected the offer).
I also accept all terms and conditions as stated in the Offer Leer as well as in the
APPENDICES.
DECLARATION OF CANDIDATE
I accept that if, in reading and completing the application form and accepting the offer, I
knowingly or carelessly provided untrue or incomplete information,
a.
any offer of admission, whether accepted or not, may be withdrawn by IIUM;
b.
I may be required to withdraw from the University or from any course in which I
am enrolled;
c.
I may be subjected to disciplinary actions.
I agree that IIUM may verify any of the information provided by contacting the relevant
institution or person. I agree to comply with all rules and regulations of IIUM, present
and future.
Signature of Student: …………………………………
Date: ….………………….
Note: If we do not receive any response from you aer the deadline as stated in the offer leer,
we assume that you are no longer interested in the programme and your offer will be
automatically revoked.
Admission Booklet
Pag e
28
APPENDIX C
IIUM-R2
Dean
P.O. Box 10, 50728 Kuala Lumpur, Malaysia
Fax No: 603-61964724
DEFERMENT FORM
(Please fill up this form)
1.
Full Name: ………………………………………………………………………................
2.
Matric. No.: ………………………………………………………………………………...
3.
Programme: ………………………………………………………………………………...
Please tick (
) one of the followings:
I would like to defer the admission to next intake
Sept. 201
Feb. 201
June 201
I also accept all terms and conditions as stated in the Offer Leer as well as in the
APPENDICES.
DECLARATION OF CANDIDATE
I accept that if, in reading and completing the application form and accepting the offer, I
knowingly or carelessly provided untrue or incomplete information,
a.
any offer of admission, whether accepted or not, may be withdrawn by IIUM;
b.
I may be required to withdraw from the University or from any course in which I
am enrolled;
c.
I may be subjected to disciplinary actions.
I agree that IIUM may verify any of the information provided by contacting the relevant
institution or person. I agree to comply with all rules and regulations of IIUM, present
and future.
Signature of Student: …………………………………
Date: ….………………….
Note: If we do not receive any response from you aer the deadline as stated in the offer leer,
we assume that you are no longer interested in the programme and your offer will be
automatically revoked.
Admission Booklet
Pag e
29

International Islamic University Malaysia

Transcription

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