APPLICATION FOR ENROLMENT

Application for:

A) PERSONAL PARTICULARS: Name (in full): Address: Postcode Town / City: State: Telephone (Home): Mobile Phone: Date of Birth (dd/mm/yyyy): Citizenship:

Gender:

Age: Height (cm): Weight (kg): BMI: NRIC: Ethnic / Race:

#DIV/0!

Place of Birth: Religion: Email Address:

B) ACADEMIC REQUIREMENTS: SPM Exam Result Year: Subject 1) Malay Language 2) English Language 3) Mathematics 4) Physics 5) Additional Mathematics

Name of school: Level Obtained in SPM

C) QUESTIONS: 1) Are you a swimmer? Answer: 2) Are you wearing visual aids (spectacles or contact lens)? Answer: If "Yes", please advise the degree of your visual aid :

(must <200 or 6/9)

3) Are you colour blind? Answer: 4) Are you suffering from any illness that may hinder you from attending any course? Answer: 5) Extra Curricula Acitivities: 5.1) Uniform Body Position / Rank 5.2) Non-Uniform Body Position / Rank 5.3) Sports Representing 6) Hobbies: Answer:

D) PARENTS / GUARDIAN INFORMATION: Father / Guardian's Name Occupation: Telephone (Home): Mobile Phone: E) EMERGENCY CONTACT DETAILS FOR NEXT OF KIN Name: Address:

Telephone (Home): Mobile Phone: Relationship: F) OTHERS 1) If you are not successful to get a sponsorship, would you consider paying on your own for this programme? Answer: 2) Does your parent work for PETRONAS, MISC Berhad or its subsidiary? Answer: If yes, please state : Name Relationship PETRONAS/MISC/Subsidiary (if subsidiary, please state the name of the subsidiary) Department Designation

G) INSTRUCTIONS TO APPLICANTS 1) This form must be completed and submitted via email to (alam2011intake@alam.edu.my ) before 1700hrs 4th APRIL 2011 and a printed copy is to be brought along on the interview day (if you are successful) together with certified photocopies of the following a) Identity Card b) School Leaving Certificates c) SPM exam result 2) Please bring along RM10 for processing fee and RM80 for administrative fee (Total RM90) Postal/Money Order payable to "Malaysian Maritime Academy Sdn. Bhd.". 3) ONLY shortlisted candidates will be notified for an interview via email. 4) Successful candidates will be required to attend the Candidate Fitness Assessment (CFA) which will consist of 6 physical tests. Only candidates who are successful in the CFA test will be offered a placement for the course.

H) DECLARATION I confirm and certify that the information given above are true. I also agree that ALAM has the right to reject my application in the event that the particulars given are found to be untrue. (Please select)

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