International Students

FIRST CHOICE

Level of Study

Programme

SECOND CHOICE

Level of Study

Programme

DETAILS OF APPLICANT

Name

First

Last

Nationality

Date

Marital Status

Married

Single

(Required by Ministry of Education)

Gender

Male

Female

Passport No

Valid Until

Correspondence Address (in Malaysia)

Correspondence Address <small>(in Malaysia)</small>

City

State/Province

Zip/Postal

Country

Tel. No. (Mobile)

Tel. No. (House)

Tel. No. (Office)

Permanent Address (if different from correspondence address above)

City

State/Province

Zip/Postal

Country

Tel. No. (Mobile)

Tel. No. (House)

Do you have any medical condition(s) that require(s) special assistance?

YES, please specify

ACADEMIC QUALIFICATIONS

Please state ALL the relevant academic qualifications (s) that you hold.

Academic Qualification

Name of Institution

Results

Year

Add Remove

English Language Achievements

TEOFL

IELTS

MUET

OtherOther

DOCUMENTS UPLOAD

Please upload all your documents (eg: academic certificate, transcript, passport-size photograph and copy of your passport) here.

DECLARATION

I certify that the information given herein is true and correct, and I acknowledge that any false and/or incorrect information or documentary evidence may result in the cancellation of my enrolment in the program of study.
I understand that the offer letter issued to me will become void if I fail to submit all the relevant documents and pay the required course fees by the due date.
I agree to inform the Registrar in writing of any change in the information given herein, and I understand that IIC will not be held liable as a result of my failure to do so.
I understand and agree that IIC shall forfeit the security deposit paid by me if I remain inactive for one year without notifying the Registrar in writing.
I understand and agree that any fees, deposits and/or monies due to me that remain unclaimed for a period of one year or more from the date of my becoming inactive in my program of study, will be transferred to any nominated education or charitable fund without further reference to me.
I understand and agree to use the technology resources and facilities at IIC for educational, academic research and study purposes only, and IIC shall not be held liable for any violation of rules and regulations relating to those resources perpetuated by me.
I hereby agree and authorise IIC to release my personal information given herein to any authorised agencies and/or bodies of IIC or its business partners for the purpose of enrolment, educational evaluation, transfer of courses and any other administrative process; and to any relevant government bodies/agencies for enforcement of the law.
I authorise and grant IIC the right to use my personal information such as name, credentials, academic record, image, and spoken and written records of my activities at IIC, in posters, leaflets, brochures, advertisements, websites, films, electronic recordings and the like for the marketing and promotion of IIC’s corporate image and programs of study, and/or any purposes incidental to it.
I understand and agree that IIC and its authorised representatives shall have unlimited use of, and exclusive rights, titles and interests including copyrights over, the materials mentioned in clause 8 herein, during and after my graduation from IIC.
I understand and agree that IIC shall release my examination results and my academic record to my parents and/or sponsor(s) as and when it is deemed necessary.
I understand and agree that if I revoke my consent to any of the terms specified in clauses 8, 9 & 10 herein, I must do so in writing to the Registrar of IIC, and that all actions taken by IIC prior to the revocation in exercise of their rights in respect of me will not be affected.
I understand and agree to comply with all policies, rules and regulations of IIC, including the rules and regulations of the respective departments, during my program of study at IIC.
I hereby declare that I have read and understood all the terms herein and agree to abide by them.

Applicant’s Name

Date

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