Denotes mandatory field which must be completed.

Personal Details

Title --- Please Select --- ASSOCIATE PROFESSOR ASSOCIATE PROFESSOR DR. CIK DATIN DATO' DATO SERI DATUK DR. ENCIK IR. MADAM MR. MRS. MS. PROFESSOR PUAN TAN SRI Please select title

Full Name (as stated in the NRIC / Passport) Please enter your full name

NRIC (new) / Passport Number Please enter your IC number

Nationality AFGHANISTAN ALBANIAN ALGERIAN AMERICAN AMERICAN SAMOAN ANGOLAN ANGUILLAN ANTIGUAN ANTILLEAN ARGENTINIAN ARMENIAN ARUBAN AUSTRALIAN AUSTRIAN AZERI BAHAMIAN BAHRAINI BANGLADESHI BARBADIAN BASOTHO BELARUSIAN BELGIAN BELIZEAN BENINESE BERMUDIAN BHUTANESE BOLIVIAN BOSNIAN BOTSWANAN BRAZILIAN BRITISH VIRGIN ISLANDER BRITON BRUNEIAN BULGARIAN BURKINABE BURMESE BURUNDIAN CAMBODIAN CAMEROONIAN CANADIAN CAPE VERDEAN CAYMANIAN CENTRAL AFRICAN CHADIAN CHILEAN CHINESE CHRISTMAS ISLANDER COCOS ISLANDER COLOMBIAN COMORIAN CONGOLESE CONGOLESE COOK ISLANDER COSTA RICAN CROAT CUBAN CYPRIOT CZECH DANE DJIBOUTIAN DOMINICAN DOMINICAN DUTCH EAST TIMORESE ECUADORIAN EGYPTIAN EMIRIAN EQUATORIAL GUINEAN ERITREAN ESTONIAN ETHIOPIAN FAEROESE FALKLAND ISLANDER FILIPINO FINN FRENCH GABONESE GAMBIAN GEORGIAN GERMAN GHANAIAN GIBRALTARIAN GREEK GREENLANDER GRENADIAN GUADELOUPEAN GUAMANIAN GUATEMALAN GUIANESE GUINEA-BISSAU GUINEAN GUYANESE HAITIAN HONDURAN HONG KONG HUNGARIAN ICELANDER INDIAN INDONESIAN IRANIAN IRAQI IRISH ISRAELI ITALIAN IVORIAN JAMAICAN JAPANESE JORDANIAN KAZAKH KENYAN KIRIBATIAN KITTSIAN KUWAITI KYRGYZ LAO LATVIAN LEBANESE LIBERIAN LIBYAN LIECHTENSTEINER LITHUANIAN LUXEMBOURGER MACANESE MACEDONIAN MAHORAIS MALAGASY MALAWIAN MALAYSIAN MALDIVIAN MALIAN MALTESE MARSHALLESE MARTINICAN MAURITANIAN MAURITIAN MEXICAN MICRONESIAN MOLDOVAN MONEGASQUE MONGOLIAN MONTSERRATIAN MOROCCAN MOZAMBICAN NAMIBIAN NAURUAN NEPALESE NEW CALEDONIAN NEW ZEALANDER NICARAGUAN NIGERIAN NIGERIEN NIUEAN NORFOLK ISLANDER NORTH KOREAN NORTHERN MARIANA ISLANDER NORWEGIAN OF FIJI OMANI PAKISTANI PALAUAN PANAMANIAN PAPUA NEW GUINEAN PARAGUAYAN PERMANENT RESIDENT OF MALAYSIA PERUVIAN PITCAIRNER POLE POLYNESIAN PORTUGUESE PUERTO RICAN QATARI REUNIONESE ROMANIAN RUSSIAN RWANDAN S?O TOM?AN SAHRAWI SAINT HELENIAN SAINT LUCIAN SAINT-PIERRAIS SALVADORIAN; SALVADORAN SAMOAN SAN MARINESE SAUDI ARABIAN SENEGALESE SERBIA AND MONTENEGRO SEYCHELLOIS SIERRA LEONEAN SINGAPOREAN SLOVAK SLOVENE SOLOMON ISLANDER SOMALI SOUTH AFRICAN SOUTH KOREAN SPANIARD SRI LANKAN STATELESS SUDANESE SURINAMESE SWAZI SWEDE SWISS SYRIAN TAIWANESE TAJIK TANZANIAN THAI TOGOLESE TOKELAUAN TONGAN TRINIDADIAN TUNISIAN TURK TURKMEN TURKS AND CAICOS ISLANDER TUVALUAN UGANDAN UKRAINIAN URUGUAYAN US VIRGIN ISLANDER UZBEK VANUATUAN VENEZUELAN VIETNAMESE VINCENTIAN WALLISIAN YEMENI ZAMBIAN ZIMBABWEAN

Date of Birth
   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec    Please enter the day of birth Please enter valid date Please enter the year of birth Please enter valid year

Gender
 Male     Female

Marital Status --- Please Select --- DIVORCED MARRIED SINGLE WIDOW/WIDOWER Please select marital status

Race --- Please Select --- AFGHANISTAN AUSTRALIA BAJAU BANGLADESH BERAWAN BHUTAN BIDAYUH BISAYA BUGIS BUMIPUTERA SABAH CAMEROON CANADA CHINESE DUSUN ECUADOR EURASIAN FINLAND FRANCE GERMANY HONG KONG IBAN INDIAN INDIAN MUSLIM INDONESIA IRAN IRAQ JAPAN JAWA JORDAN KADAZAN KADAZAN-DUSUN KAYAN KEDAYAN KELABIT KENYAH KENYAN KOREA KUWAIT LUN BAWANG MALAY MAURITIUS MELANAU MURUT/LUN BAWANG MYANMAR NEPALESE NETHERLANDS NIGERIA NOT AVAILABLE ORANG ASLI OTHERS PAKISTAN PENAN/PUNAN PHILIPPINES PORTUGUESE PUNJABI RUNGUS SAUDI ARABIA SIAMESE SINGAPORE SINHALESE SINO-CHINESE SINO-KADAZAN SINO-NATIVE SOUTH AFRICA SRI LANKA STATELESS SULUK TAIWAN TANZANIA THAI MUSLIM THAILAND TURKMENISTAN ULU AI - SARAWAK UNITED KINGDOM UNITED STATES OF AMERICA VENEZUELA VIETNAM YEMEN   Please select your race Please Specify:

Contact Details

Postcode Please enter your postcode number

City/Town Please enter your city name

State --- Please Select --- JOHOR KEDAH KELANTAN KUALA LUMPUR LABUAN MELAKA NEGERI SEMBILAN PAHANG PENANG PERAK PERLIS SABAH SARAWAK SELANGOR TERENGGANU WILAYAH PERSEKUTUAN Please select state

Country AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA17 BOTSWANA BRAZIL BRITISH VIRGIN ISLANDS BRUNEI BULGARIA BURKINA FASO BURUNDI C?TE DIVOIRE CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO27 COOK ISLANDS COSTA RICA CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC REPUBLIC OF THE CONGO32 DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FAEROE ISLANDS FALKLAND ISLANDS FIJI FINLAND FORMER YUGOSLAV REPUBLIC OF MACEDONIA FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI45 KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR51 NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTH KOREA NORTHERN MARIANAS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN ISLANDS POLAND PORTUGAL PUERTO RICO QATAR R?UNION ROMANIA RUSSIA RWANDA S?O TOM? AND PR?NCIPE SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAUDI ARABIA SENEGAL SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SPAIN SRI LANKA STATELESS SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA THAILAND THE BAHAMAS THE GAMBIA TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY US VIRGIN ISLANDS UZBEKISTAN VANUATU VENEZUELA VIETNAM WALLIS AND FUTUNA WESTERN SAHARA85 YEMEN ZAMBIA ZIMBABWE

Email Please enter your email Please enter a valid email

Mobile Number
  -  
Please enter prefix number Please enter valid prefix number Please enter your phone number Please enter valid phone number

If your current correspondence address is similar to your permanent correspondence address, click on this button to copy.

 

Permanent Address Please enter your address

Contact Number - Office
  -   Invalid Prefix  Invalid Phone Number

Contact Number - Home
  -    Invalid Prefix Invalid Phone Number

Postcode Please enter your postcode number

City/Town Please enter city name

State --- Please Select --- JOHOR KEDAH KELANTAN KUALA LUMPUR LABUAN MELAKA NEGERI SEMBILAN PAHANG PENANG PERAK PERLIS SABAH SARAWAK SELANGOR TERENGGANU WILAYAH PERSEKUTUAN Please select state

Country AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA17 BOTSWANA BRAZIL BRITISH VIRGIN ISLANDS BRUNEI BULGARIA BURKINA FASO BURUNDI C?TE DIVOIRE CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO27 COOK ISLANDS COSTA RICA CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC REPUBLIC OF THE CONGO32 DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FAEROE ISLANDS FALKLAND ISLANDS FIJI FINLAND FORMER YUGOSLAV REPUBLIC OF MACEDONIA FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI45 KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR51 NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTH KOREA NORTHERN MARIANAS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN ISLANDS POLAND PORTUGAL PUERTO RICO QATAR R?UNION ROMANIA RUSSIA RWANDA S?O TOM? AND PR?NCIPE SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAUDI ARABIA SENEGAL SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SPAIN SRI LANKA STATELESS SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA THAILAND THE BAHAMAS THE GAMBIA TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY US VIRGIN ISLANDS UZBEKISTAN VANUATU VENEZUELA VIETNAM WALLIS AND FUTUNA WESTERN SAHARA85 YEMEN ZAMBIA ZIMBABWE

Emergency Contact Details

Name Please enter a name

Relationship --- Please Select --- BROTHER FATHER HUSBAND MOTHER RELATIVE SISTER WIFE Please select relationship

Email Please enter email Please enter a valid email

Contact Number
  -   Please enter prefix number Please enter valid prefix number Please enter phone number Please enter valid phone number

Preferred Regional Centre: Please select Regional Center

Intended Programme of Study:

 
Please select program

Program Name:

Education Background

(Please list from the highest to the lowest qualification)

Qualification/Achievement

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Institute

Specialisation

 

Qualification/Achievement

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Institute

Specialisation

Qualification/Achievement

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Institute

Specialisation

Qualification/Achievement

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Institute

Specialisation

Qualification/Achievement

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Institute

Specialisation

Qualification/Achievement

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Institute

Specialisation

Qualification/Achievement

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Institute

Specialisation

Qualification/Achievement

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Institute

Specialisation

Work Experience

(Please state the most current one first)

Organisation

Position

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Knowledge

 

Organisation

Position

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Knowledge

Organisation

Position

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Knowledge

Organisation

Position

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Knowledge

Organisation

Position

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Knowledge

Organisation

Position

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Knowledge

Organisation

Position

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Knowledge

Organisation

Position

From

Invalid Month Invalid Year

To


Invalid Month Invalid Year

Knowledge

WORK EXPERIENCE

(Please state the most current one first)

* denotes compulsory field which must be completed.

Declaration:

	• I declare that all information given in this application form and the attached documents are accurate and complete. • I consent that if registered, I will conform to the Constitution and Rules and Regulations of the University. • I authorize the University to obtain information from any of my previous or current educational institution/employer. • I understand the University reserves the right to vary, reject or reverse any decision made on the basis of untrue, incomplete or misleading information. • I give consent to the University to collect and process my personal data in accordance with their policies as per the Privacy Statement published in the University's corporate website (www.wou.edu.my) and the Personal Data Protection Act (2010). • I acknowledge that it is my responsibility to constantly update myself on the latest information embedded in the Student Handbook and other publications which can be retrieved from the Student Portal (https://my.wou.edu.my)
	I agree to the above declaration