REGISTRATION FORM

OFFICE USE ONLY

Student ID No.

Registration

Counseled by
Introduced by

:
:

Registration Fees paid

Tuition Fees paid
Documents Complete

:
:
:

Malaysian

International
Date :

Yes
Yes
Yes

No
No
No

Photo

Date :
Date :
Date :

Please fill up ALL sections of this form in CAPITAL LETTERS and duly signed it.
Enclose certified true copies of all required documents.

SECTION 1 :

PROGRAMME PREFERENCE

Intake

Certificate
Master
Programme
:

Month :
Foundation
Ph.D

Year :
Diploma
Others:

Degree

Would you like to accept an offer to another programme?

Yes, please specify :
No

SECTION 2 :

PERSONAL INFORMATION

Name of Applicant :
Surname
:
NRIC/Passport No :
Gender
:
Race
:
Religion

Marital Status

Address
Postcode
State
Telephone No.

:
:
:
:

Date of Birth :
Male
Malay
India
Muslim
Christian
Single
Widowed

Female
Nationality :
Chinese
Others :
Buddhist
Hindu
Others :
Married
Divorced
Others :
Town
:
Email Address :
Mobile No.
:
1

REGISTRATION FORM
DETAILS OF
FAMILY MEMBERS
Name
Address
Postcode
Town
State
Occupation
Salary
Company Name
Office No.
Mobile No.

Father

Mother

Guardian (if any)

:
:
:
:
:
:
:
:
:
:

EMERGENCY CONTACT DETAILS

Name
Relationship
Address
Postcode
Office No.

:
:
:
:
:

SECTION 3 :

INTERNATIONAL STUDENT ONLY

Town
Mobile No.

:
:

Are you holding any type of Malaysian Immigration Pass now?

If yes, please specify

Immigration Pass Expiry Date

Social Visit
Dependent

Yes

No

Student
Diplomatic

Applicable to students / former students from other institution in Malaysia only

Institution
Course
Year / Duration

:
:
:

Applicable to students from the Peoples Republic of China only

Please specify as to which Malaysian Consulate you wish to obtain your single entry
visa to Malaysia?
Shanghai
Beijing
Guangzhou

REGISTRATION FORM
SECTION 4 :

ACADEMIC QUALIFICATION

Please tick the box based on the academic qualification(s) that you possess and enclose all relevant documents.
Please attach original or/and certified copies (with official signature or/and stamp) of all transcripts provided by insituitions you have listed
below. Applicant(s) who submit document(s) in a language other than English must provide an officially certified translation, together with the
original documents.

Qualification :

No

SPM
STPM
O LEVEL
A LEVEL
Others:

Subject

Year Completed :
Year Completed :
Year Completed :
Year Completed :
Year Completed :

Grade

No

10

11

12

CGPA / Grade
Name of Course

Subject

Grade

:
Name of Insituition
& Country

SECTION 5 :

Course Length
(Start date & Completion date)

Major of
Discipline

Class or Grade Awarded

(e.g Honor 2nd upper or your GPA)

ENGLISH PROFICIENCY

Please provide relevant supportive documents.

Do you have English Language Qualification?

If yes, please specify

Yes

No

:
Score

Date

Reference No.

TOEFL
IELTS
LUC Language Test
3

REGISTRATION FORM
SECTION 6 :

FINANCIAL ASSISTANCE

Sponsored by Employer
Sponsored by Government
Scholarship

Self Finance
Others :

Please attach relevant supportive documents.

Company Name
Address
Postcode
State
Office No.

:
:
:
:
:

SECTION 7 :

DECLARATION BY APPLICANT

Town
Country
Mobile No.

:
:
:

I, declare that the information given in this registration form is complete and accurate to the best of my knowledge. I
understand that withholding information or/and giving false information will make me ineligible for admission. I also
understand that I may be required to attend for an interview or undergo such test that may be requested by the
University College as a requirement for admission to the programme of study for which I have applied.
I, further confirm and consent to the use by Lincoln University Colleges, without charge, my personal information
(including photographs or/and images or/and recordings of the student) in any publicity or/and promotional
exercise of Lincoln University Colleges including without limitation, the publishing of good examination results, the
award of a prize or/and scholarship, any achievement, academic or otherwise. I hereby authorize Lincoln University
Colleges to release such relevant information to the relevant Alumni Association .

Signature of Applicant
Name of Applicant :
NIRC/Passport No. :
Date
:
Office Use Only

Registrar

Dean/Coordinator of Faculty
4