A. APPLICATION DETAILS
Programme of Study
(*)
:
Please Select
MSc in Petroleum Engineering by Coursework & Dissertation
MSc in Petroleum Geoscience by Coursework & Dissertation
MSc in Process Integration by Coursework & Dissertation
MSc in Asset Management by Coursework & Dissertation
MSc in Advance Process Control by Coursework & Dissertation
MSc in Electronic System Engineering by Coursework & Dissertation
MSc in Chemical Engineering by Research
MSc in Petroleum Engineering by Research
MSc in Petroleum Geoscience by Research
MSc in Civil Engineering by Research
MSc in Mechanical Engineering by Research
MSc in Electrical & Electronic Engineering by Research
MSc in Information Technology by Research
PhD in Chemical Engineering by Research
PhD in Petroleum Engineering by Research
PhD in Petroleum Geoscience by Research
PhD in Civil Engineering by Research
PhD in Mechanical Engineering by Research
PhD in Electrical & Electronic Engineering by Research
PhD in Information Technology by Research
Mode of Study
(*)
:
Please Select
Full Time
Part Time
Academic Year
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:
Please Select
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Intake
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:
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Jan
July
For Research Programmes Only:
Area of Specialization :
Proposed Research Title :
Proposed Supervisor :
B. PERSONAL DETAILS
Full Name
(*)
:
Gender
(*)
:
Please Select
Male
Female
NRIC / Passport No
(*)
:
eg: 756233025415
Date of Birth
(*)
:
dd/mm/yyyy
Place Of Birth
(*)
:
Age
(*)
:
Marital Status
(*)
:
Please Select
Single
Married
Divorced
Nationality
(*)
:
Ethnicity :
Religion
(*)
:
Mailing Address
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:
Postcode
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:
City
(*)
:
State / Province
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:
Country
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:
Tel No
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:
Mobile No :
Email
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:
Please provide valid email
Permanent Address @ Home Country (if different from Mailing address) :
Postcode :
City :
State / Province:
Country :
C. QUALIFICATIONS
Please provide details of degree obtained from University / College / Other Tertiary Institutions
Academic Qualification Obtained
(*)
Result / Achievement (CGPA or equivalent)
(*)
Name of Institution
(*)
Period of study
(*)
Language of Instruction
(*)
From
(mm/yyyy)
To
(mm/yyyy)
Other Professional Qualifications :
Research Experience:
Publication (provide citations):
D. LANGUAGE PROFICIENCY
Proficiency in Malay language (For local applicants only)
Proficiency in Malay language in SPM/MCE
Grade
Year Passed
Proficiency in English language (For all applicants)
Test
Date Taken
(dd/mm/yyyy)
Grade/Point Obtained
1.
2.
3.
4.
E. WORKING EXPERIENCE
Please provide details of current and previous employment (start with the most recent)
Present Position :
Since :
(dd/mm/yyyy)
Business Address :
Postcode :
Country :
Tel No :
Fax No :
Email :
From
(dd/mm/yyyy)
To
(dd/mm/yyyy)
Position and Nature of Work
Employer
F. FINANCIAL SUPPORT
Please indicate your source of financial support while studying in UTP (
*
)
I am a self-financed student/have financial support from my family
I am fully sponsored by my home government/empoyer/other organization (attach evidence)
I am awarded a scholarship by
(attach evidence)
I am applying for UTP Graduate Assistantship Scheme (GA) -
Research and Full-time only
. If it is unsuccessful, I wish to study as a full-fee student
Please Select
Yes
No
G. REFEREES
Please provide details of two referees who are able to comment on your academic capabilities.
Name (
*
)
Organization (
*
)
Tel. No. (
*
)
Email Address
1.
2.
H. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
Name (
*
):
Relationship (
*
):
Address (
*
):
Postcode :
City :
State / Province :
Country (
*
):
Tel No (
*
):
Fax No :
Email :
I. DECLARATION
I hereby declare that I have personally filled in this Application Form and that the information contained herein is complete and accurate to the best of my knowledge. I understand that withholding or giving false information will make me ineligible for admission and future enrollment. I further understand that if at any time the information or part thereof stated in this declaration is found contrary to facts, the University has the authority to disqualify, or if I am already admitted, to terminate my candidature.
Signature of Applicant
Date
Note:
(*)
is required field.