CENTRE FOR GRADUATE STUDIES

UNIVERSITI MALAYSIA PERLIS

To all applicants
Postgraduate Program
Universiti Malaysia Perlis
Thank you for choosing Universiti Malaysia Perlis !
While filling in the form , please pay attention to the following :

Fill in the form in block letters using a black pen or a typewriter ;

All sections must be filled in. State not applicable wherever necessary.

The completed application form must be submitted with the following documents :
i)

Malaysian Applicants
Money Order of RM 50.00 for processing fee to Bendahari UniMAP.
International Applicants
Non-refunable processing fee of USD 30 in form of bank draft made payable to the Bendahari UniMAP.

ii)

2 certified copies degree/equivalent qualifications, Teaching English as a Foreign Language (TOEFL) / International English
Language Testing System (IELTS) or any other English tests that are equivalent, professional certificates and full Academics
Transcripts. Applicants in their final semester of first degree must attach certified copies of result for every semester;

iii)

Letter of undertaking for Scholarship/training award/study loan ;

iv)

Letter of approval/official leave from employer/relevant authorities to pursue this programme.

v)

Copy of research proposal (for research mode applicants)

vi)

Four (4) copies of every used pages of International passport and four (4) copies of passport-sized colored photograph for
student pass / visa application ;

Please be informed that the acknowledgment letter must be completed and sent together with the application form. Only the
completed form will be processed. Please address your application to :
Dean
Centre for Graduate Studies
Universiti Malaysia Perlis
112 & 114 (First Floor) Block A
Taman Pertiwi Indah
Jalan Kangar Alor Setar, Seriab
01000 Kangar
Perlis
MALAYSIA
Looking forward to seeing you at UniMAP. Thank you.

UniMAP/UIT/PIT01

PIT01
UNIVERSITI MALAYSIA PERLIS

Please affix a
recent passport
size photograph

PUSAT PENGAJIAN SISWAZAH

Centre for Graduate Studies
PERMOHONAN IJAZAH TINGGI
POSTGRADUATE APPLICATION
A. BIDANG PENGAJIAN / FIELD OF STUDY
Sila tanda ( ) di mana berkenaan / please tick ( )where applicable
(i) Program yang dipohon
Proposed Program

Ph.D

Sarjana Sains
Master of Science

M.Sc/Ph.D
(Malaysian only)

(ii) Mod Pengajian

Study Mode

Penyelidikan
Research

Mod Campuran
Mixed Mode

Kerja Kursus
Coursework

PhD Industri
(Malaysian
only)

(iii) Mod Pendaftaran

Sepenuh masa
Sambilan
Registration Mode
Full time
Part time
______________________________________________________________________________________________________________________________________________________
I.

Mod Penyelidikan (Research Mode)

Pusat Pengajian
School
Program

* Tajuk Penyelidikan
* Research Title

Penyelia Dicadangkan
Proposed Supervisors

*Sila kepilkan cadangan penyelidikan anda bersama borang permohonan

*Please enclose your research proposal with the application form
Penyelia Utama
Penyelia Bersama
Main Supervisor
Co-Supervisor
(1)
Nama
Name

Penyelia Bersama
Co-Supervisor
(2)

Jawatan
Post

Pusat
Pengajian
School

UniMAP/UIT/PIT01

II.

Mod Campuran (Mixed Mode)

Pusat Pengajian
School
Program

III.

Mod Kerja Kursus (Coursework Mode)

Pusat Pengajian
School
Program

______________________________________________________________________________________________________________________________________________________
B. BUTIR-BUTIR PERIBADI / PERSONAL DETAILS
(sila taip atau tulis dalam HURUF BESAR / please type or write in BLOCK LETTERS)
1. Nama Penuh (mengikut kad pengenalan /pasport) Full Name (as written in identity card/passport)

2. No. Kad Pengenalan / Identity Card No

4. Tarikh Lahir/Date of Birth

/
/
hari/day

bulan/month

3. No. Pasport / Passport No.

5. Umur/Age

6. Jantina / Gender

tahun/ year

7. Taraf Perkahwinan / Marital Status

Sila tanda ( )di mana berkenaan / please tick ( )where applicable
Bujang/Single

Berkahwin/Married

8. Kewarganegaraan / Nationality

9.Bangsa / Race

10. Alamat Tetap/ Permanent Address

Poskod/Postcode

Bandar / City

Negeri & Negara / State & Country

11. Alamat Surat- Menyurat / Correspondence Address

Poskod/Postcode

UniMAP/UIT/PIT01

Bandar / City

Negeri & Negara / State & Country

No. Telefon / Telephone No.

Rumah
Home

Pejabat
Office

Faks / Fax

Bimbit
Cellular
Emel / Email

WARIS TERDEKAT/ NEXT-OF-KIN

(sila taip atau tulis dalam HURUF BESAR / please type or write in BLOCK LETTERS)
12. Nama / Name
13. Hubungan / Relationship

14. Alamat Surat - Menyurat / Correspondence Address

Poskod/Postcode

No. Telefon / Telephone No.

Rumah
Home

Bandar / City

Negeri & Negara / State & Country

Pejabat
Office

Faks / Fax

Bimbit
Cellular
Emel / Email

C. PENGALAMAN BEKERJA / WORKING EXPERIENCE

Tarikh / Date
Dari
Hingga
From
To

Jawatan Dipegang
Position Held

D. KELAYAKAN AKADEMIK / ACADEMIC QUALIFICATIONS

Universiti/Institusi
Nama Ijazah Diperoleh
Tahun Masuk
University/Institution
Name of Degree Awarded
Year of Entry

Nama & Alamat Majikan

Name & Address of Employer

Tahun Berijazah
Year of Graduation

Kelas Kepujian/ PNGK

atau setaraf*
Honours Classification
/CGPA or equivalent*

* Untuk pelajar yang AKAN berijazah, sila nyatakan PNGK terkini / For GRADUATING students, state the latest CGPA

UniMAP/UIT/PIT01

E. KEMAHIRAN BAHASA INGGERIS / ENGLISH LANGUAGE PROFICIENCY

Ujian / Test

Tarikh / Date

Gred/Skor
(Grade/Score)

1.
2.
3.
* Sila sertakan salinan keputusan yang telah disahkan / Attach certified copy of the results
F. BANTUAN KEWANGAN / FINANCIAL SUPPORT
Sila tanda ( )di mana berkenaan / please tick ( )where applicable
Biasiswa / Scholarship
Saya dibiayai penuh oleh majikan / kerajaan negara saya (sertakan dokumen berkenaan)
I am fully sponsored by my employer/ home government (attach relevant documents)
Saya dibiayai sendiri / oleh keluarga saya
I am supporting myself / by my family
Lain lain ( sila nyatakan) __________________________________
Others (please specify)
Sila kemukakan salinan penyata akaun bank yang disahkan/surat jaminan pembiayaan
Please attach certified photocopy of statement of bank account/Letter of financial guarantee
Nama dan alamat penaja atau organisasi yang akan membiayai pengajian anda
Name and address of person or organization sponsoring you

G. PENGALAMAN PENYELIDIKAN / RESEARCH EXPERIENCE

Tajuk
Title
1.

Penganjur
Organizer

Tempoh
Duration

2.
3.
4.
5.

UniMAP/UIT/PIT01

H. PENGADIL / REFEREES
Sila nyatakan dua orang pengadil yang mengenali anda. Pastikan pengadil menggunakan borang laporan pengadil yang
disertakan.
Name two referees for your application. Ensure your referees use the referees report form attached.
(1)

(2)

Nama/Name
Jawatan/Position
Alamat / Address
No. Telefon / No. Faks
Telephone No./ Fax No.
Emel / Email
I. PERAKUAN / DECLARATION
Saya akui bahawa segala maklumat dan dokumen yang saya berikan adalah benar dan lengkap. Saya menyedari bahawa
Universiti Malaysia Perlis berhak menolak permohonan saya / menarik balik tawaran kemasukan sekiranya maklumat
serta dokumen didapati tidak benar dan tidak lengkap.
I hereby declare that all information and documents provided are true and complete. I acknowledge that Universiti Malaysia Perlis may
reject my application / withdraw the offer of admission if the information and documents provided are found to be untrue or incomplete.
......................

..........................................

Tarikh /Date

Tandatangan / Signature

UniMAP/UIT/PIT01

J. PANDUAN MENULIS CADANGAN PENYELIDIKAN / GUIDELINE IN WRITING RESEARCH PROPOSAL

Sila rujuk lampiran PIT 01 A seperti yang disertakan. / Kindly refer to attachment PIT 01 A as included.
Sila kembalikan borang yang lengkap kepada/ Please return the complete form to:
Pusat Pengajian Siswazah
Universiti Malaysia Perlis (UniMAP)
No. 112 & 114 (Tingkat Satu)
Taman Pertiwi Indah
Jalan Kangar Alor Setar, Seriab
01000, Kangar
Perlis
MALAYSIA
Centre for Graduate Studies
Universiti Malaysia Perlis (UniMAP)
No. 112 & 114 (First Floor)
Taman Pertiwi Indah
Jalan Kangar Alor Setar, Seriab
01000, Kangar
Perlis
MALAYSIA

UniMAP/UIT/PIT01

Untuk Kegunaan Pejabat Sahaja / For Office Use Only

1. KELULUSAN PENGAJIAN IJAZAH TINGGI /POSTGRADUATE OFFICE APPROVAL
Borang PIT01/PIT01 Form
Borang PIT02/PIT02 Form (diisi oleh 2 orang pengadil (filled by 2 referees)
2 salinan ijazah yang disahkan /2 copies of certified degree
2 salinan transkrip yang disahkan /2 copoes of certified transcript
2 salinan ujian Bahasa Inggeris yang disahkan/2 copies of certifies English language test
2 salinan kad pengenalan yang disahkan /2 copies of certified identity card
2 salinan surat beranak yang disahkan /2 copies of certified birth certificate
4 Salinan pasport (untuk pemohon antarabangsa)/4 Copies of international passport(for international applicant)
4 keping gambar berukuran pasport (1 dilekatkan pada Borang Permohonan PIT01) /
4 copies of passport size photograph (1 is fixed to the Application Form PIT01)
Yuran proses / Processing fee : RM 50.00 (Malaysian Applicant) / USD 30 (International Applicant)
Dokumen pembiayan pengajian /sponsorship document
Surat kebenaran sambung belajar dari majikan (pelajar Sambilan) / Letter of approval from Employer (Part Time
students)
Cadangan Penyelidikan (calon Mod Pengajian) / Research Proposal (Research Mode candidate)
Catatan
Remarks
___________________________________________________________________

Tandatangan Pegawai / Officers Signature : ______________

Tarikh / Date : _____________

2. PERAKUAN JAWATANKUASA IJAZAH TINGGI PUSAT PENGAJIAN /SCHOOLS
POSTGRADUATE STUDIES COMMITTEE APPROVAL BIL. _____________
Diterima untuk /Accepted for

Mod Pendaftaran / Registration Mode

Sarjana / Master

Sepenuh Masa / Full Time

Doktor Falsafah / Ph.D

Sambilan / Part Time

Mod Pengajian / Study Mode

Penyelidikan
Research

Program
Programme
Bidang Penyelidikan
Field of Research
Tajuk Penyelidikan
Research Title

Mod Campuran
Mixed Mode

Program
Program

Kerja Kursus
Coursework

Program
Program

Tandatangan Dekan Pusat Pengajian dan cop rasmi : ___________________

Deans Signature and official stamp
Tarikh /Date : _____________

UniMAP/UIT/PIT01

PUSAT PENGAJIAN SISWAZAH

UNIVERSITI MALAYSIA PERLIS
SENARAI SEMAK PERMOHONAN
(Application Check List)
Tandakan bagi perkara-perkara yang disertakan dalam ruang yang disediakan
( Please tick in the column for the documents which are enclosed )
No.
Dokumen Yang Diperlukan
( Documents required )
Wang pos bernilai RM 50.00 sebagai yuran proses bagi pemohon Malaysia atas nama
BENDAHARI UniMAP
1
Non-refunable processing fee of USD 30 in form of bank draft made payable to the Bendahari
UniMAP(for international students)
2
3

5
6
7
8
9

Tandakan
( Tick )

Borang Permohonan (PIT 01) yang lengkap diisi dan bertandatangan

Complete and signed application form (PIT 01)
Empat (4) keping gambar dengan satunya dilekatkan di borang permohonan
Four (4) copies of recent photograph , and one is fixed to the application form
2 salinan kad pengenalan, surat beranak, ijazah/kelulusan setaraf, sijil kelulusan profesional
dan transkrip akademik lengkap serta sijil TOEFL/IELTS (pelajar antarabangsa) yang telah
disahkan . Salinan sah keputusan peperiksaan akhir bagi setiap semester (bagi pemohon dalam
tahun akhir pengajian )
2 copies of birth certificate, certified degree/ equivalent qualifications professional certificates
and full academic transcripts together with certificate of TOEFL/IELTS. Certified copies of results
for every semester for applicants in their final year
Dua (2) salinan borang pengadil (PIT 02) daripada dua (2) orang pengadil
Two (2) copies of referee form from two (2) referees
Empat (4) salinan setiap mukasurat pasport antarabangsa serta Empat (4) keping gambar
berukuran pasport untuk urusan permohonan pas pelajar (bagi pemohon luar negara sahaja )
Four (4) copies of every page of the international passport and four (4) copies of passport sized
colour photos for the student pass application process (for international applicants only)
Surat pengesahan pembiayaan pengajian (jika ada)
Scholarship/training/study loan certification letters (if any)
Surat kebenaran sambung belajar bagi pelajar Sambilan (Mod Penyelidikan sahaja)
Letter of approval/official leave from employer /relevant authorities to pursue this programme
for Part Time students (Research Mode only)
Kertas cadangan penyelidikan (Mod Penyelidikan sahaja)
Research proposal (Research Mode only)

NAMA
(NAME)
PROGRAM
(PROGRAMME)
PUSAT PENGAJIAN
(SCHOOL)
TANDATANGAN
(SIGNATURE)
*attach this checklist together with the complete application form

UniMAP/UIT/PIT01

RESEARCH PROPOSAL
Name
:
School
:
Program
:
MSc
Field of Research
:
Proposed Supervisor (if any):

PIT01-A

Ph.D

Title:

Problems statement:

Objective:

Scope:

Research Description:
(300 words)

UniMAP/UIT/PIT01

10

Universiti Malaysia Perlis

Centre for Graduate Studies
112 & 114, Block A, Taman Pertiwi Indah
Jalan Kangar Alor Setar, Seriab
01000,Kangar, Perlis
MALAYSIA
Tel: 6 04-979 8333/8331/8336

Please affix
stamp here

CGS LETTER OF ACKNOWLEDGEMENT

Applicants Name

Applicants Address

.
..............................

Country .. Postcode
Degree Programme Applied For:

Research Field

PhD

MSc

MBA

..

Research Mode

Mode of Study

Mixed Mode
Coursework Mode
-------------------------------------------------------------------------------------------------------------------------------------------------------------------Dear Sir/Madam,
Application for Admission to Postgraduate Programme
We have received your application forms for PhD / Master in .
1.

You will be informed as soon as a decision is made on your application.

2.

We are unable to process your application because the following item(s) were not
enclosed/have not been received:
a.

Processing fee of RM 50.00 of postal money (Malaysian applicants) / USD 30 of bank draft
(international applicants)

b.

Two (2) certified true copies of Degree Scroll/Academic transcript.

c.

b.

Other documents (as indicated below):

Thank you.

for Centre for Graduate Studies

UniMAP/UIT/PIT01

..
Date

11