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Application Form
The Starting Edge
1. PERSONAL DETAILS
Family Name/Last Name: Given Name(s):
Passport Number or IC (if Malaysian): Nationality:
Date of birth (dd/mm/yyyy): Age: Gender:
Male / Female
Postal address: Telephone contact (with international code)
Home: Mobile:
Email Address:
2. QUALIFICATIONS
2.1 GENERAL EDUCATION BACKGROUND Current Education
Level
(e.g. Secondary Form 5, High School Year 3)
Institution Certificate Attained
(e.g. PT3, O Level)
Expected Certificate to be Awarded
(e.g. SPM, A Level)
2.2 ENGLISH PROFICIENCY
Test Results Date of Test Taken
☐ IELTS
☐ Others (Please state the test):
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3. EMERGENCY CONTACT DETAILS
Name of Emergency Contact Person: Relationship to applicant:
Postal address: Telephone contact (with international code)
Home/Office: Mobile:
Email Address:
4. PAYMENT DETAILS
Will you be paying for the course yourself? ☐ YES ☐ NO 4.1 If YES, please use one of the following payment methods: -
A. CREDIT CARD (MASTERCARD OR VISA ONLY)
Step 1 : Go to https://epay.nottingham.edu.my/
Step 2 : Select the appropriate programme name in the ‘Fees Name’ CELE Transition Programmes – Starting Edge Step 3 : Make payment
Step 4 : Attach payment slip to your registration form
B. BANK TRANSFER (TELEGRAPHIC TRANSFER) OR DIRECT BANK-IN to either of the
following banks:
HSBC Bank Malaysia Berhad
Bank Account Number: 301-879391-101 Swift code: HBMBMYKL
Affin Bank Berhad
Bank Account Number: 100260005567
Step 1 : Indicate the reference in your transaction slip
CELE Transition Programmes – Starting Edge Step 2 : Submit the registration form
Attach proof of transaction to your registration form
Email the copy to the correspondence email address
C. CROSSED CHEQUE OR BANK DRAFT payable to 'The University of Nottingham in Malaysia
Sdn Bhd':
Step 1 : Indicate the reference
CELE Transition Programmes – Starting Edge
(Write the name of the remitter at the back of the cheque or bank draft and post to the correspondence address.)
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Step 2 : Submit the registration form
Attach an electronic-copy of your cheque to your registration form
Email the copy to the correspondence email address
Please ensure that the fees are paid in full by April 2016. Failure to do so may result in the loss of your reserved spot.
4.2 If NO, please provide contact details of your sponsor, including any reference code your
sponsor may require: -
Sponsor Details
Name: Reference code:
Postal address: Telephone contact (with international code)
Home/Office: Mobile:
Email Address:
5. SOURCE
Where did you learn about The Starting Edge?
☐ Internet ☐ University ☐ Employer ☐ Advertisement
☐ Friends ☐ Previous students ☐ Colleagues
☐ Others (please specify):
_________________________________________________
6. OTHER PERSONAL DETAILS
1. Are you a vegetarian? ☐ YES
☐ NO
Note:
___________________________________________________________ ___________________________________________________________
2. Are you allergic to any food/medicine/environmental factors? ☐ YES
☐ NO
Note:
___________________________________________________________ ___________________________________________________________
3. Are you under specific medication? ☐ YES
☐ NO
Note:
___________________________________________________________ ___________________________________________________________
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4. Do you have any disabilities?☐ YES ☐ NO
Note:
___________________________________________________________ ___________________________________________________________
5. For international students, will you be using our pick up services?
☐ YES (Please select) ☐ NO
☐ Airport pick-up (KLIA to campus) ☐ Airport drop-off (campus to KLIA)
6. OTHER INFORMATION
1. What would you like to learn in this course?
☐ Communication ☐ Listening ☐ Reading ☐ Writing
☐ Presentation ☐ Critical thinking ☐ Pronunciation ☐ Study skills ☐ Research ☐ Others (please specify):
_____________________________
2. The CELE Transition Programmes consist of The Starting Edge and The Leading Edge. In addition toThe Starting Edge, what other module(s) would you be interested in? ☐ Digging in Deep ☐ Taking Centre Stage
☐ Learning the DIY Way ☐ Between the Lines ☐ Thinking like Sherlock ☐ Building Writing Blocks ☐ Gift of the Gab ☐ Wielding Words 1 ☐ Hear Me Out ☐ Wielding Words 2
3. What other courses would you like to attend?
☐ Networking ☐ Time management ☐ E-learning ☐ Note-taking ☐ Leadership and
management ☐ Others (please specify):
_____________________________
4. When would you like to attend these courses?☐ January ☐ April ☐ July ☐ October
☐ February ☐ May ☐ August ☐ November
☐ March ☐ June ☐ September ☐ December
5. Name three colleges/universities you would like to study in:
a. ___________________________________________________________________________ b. ___________________________________________________________________________ c. ___________________________________________________________________________
6. Which areas would you consider studying in the university? (You may tick more than one.)
☐ Arts & Design ☐ English Language & Literature ☐ Humanities
☐ Engineering ☐ Information Technology ☐ Medicine
☐ Health Sciences ☐ Psychology ☐ Sciences
☐ Agriculture & Forestry ☐ Environmental Sciences ☐ Accounting & Finance
☐ Business & Management ☐ Business & Management ☐ Education
☐ Economics ☐ Communication & Media Studies ☐ Law
☐ Politics & International Studies ☐ Sociology ☐ Others (please specify):
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7. What are some of the extracurricular activities you participated in? (For example: St. JohnAmbulance, Interact Club, the English Society, Football Club, Chess Club etc.)
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
8. What career would you be interested in pursuing?
________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
8. DECLARATION AND SIGNATURE
I declare that the information supplied in this form is true to the best of my knowledge and belief.
Signature:*……… Date: ………
*You may be required to sign this form in person at the start of your course.
*Please return your completed application form and the proof of payment to CELE The Edge Transition Programmes: [email protected]
Disclaimer: Although all possible care has been taken in the preparation of this form, no
responsibility can be taken for any errors or omissions. Should a course need to be cancelled due to unforeseen circumstances, the applicant will be offered an alternative course or a full refund of tuition fees and accommodation deposit.
FOR OFFICE USE ONLY:
