MALAYSIA

Please check  the relevant boxes.
Undergraduate

Postgraduate

MalaysianInternational

Student name (as per IC / Passport):

Application Form
Instructions:
1. Please fill out this form in pen or apply online at http://www.monash.edu.my/study/apply/application-form/online-application
2. Enclose all supporting documentation with this application (all documents must be certified by a recognised authority). Please note that
incomplete documentation may delay the application process.
3. An application fee of RM100, USD38, or AUD35 (non-refundable) is payable upon submission of this form. Payment must be made payable toMONASH UNIVERSITY MALAYSIA SDN. BHD. via any of the options below:a) By cash (Ringgit Malaysia Denomination only), credit card, crossed cheque or bank draft at the Financial Services Cashier Counter, Level 1,
Building 2, Monash University Malaysiab) By direct bank-in, interbank GIRO or telegrahic transfer at:
Name of Bank:
Public Bank Berhad (Bandar Sunway branch)
Address of Bank:
No. 48 & 50, Jalan PJS 11/28A, 46150 Bandar Sunway, Selangor Darul Ehsan
Account No.:307 412 960 5
Swift Code:PBBEMYKLc) Online payment via credit card is available at http://finapps.monash.edu.my/ebpg/
For option 3.b) and 3.c), kindly attach the copy of the transaction slip or remittance advice together with Application Form tothe Admissions Office. Please include the applicant’s full name and date of birth in the reference section of the payment.
4. This application is the property of Monash University Malaysia. Supporting documentation will NOT be returned.
5. It is your responsibility to advise Monash University Malaysia regarding any change of address.
6. Email your application to: mum.admissions@monash.edu
For international students only
7. You are required to refer to http://www.monash.edu.my/study/apply/intake-periods for intake periods and admission deadlines to ensure
enough time for your Student Pass application to be processed.
8. Please note that strict deadlines have been set to facilitate the Student Pass application process. If the Student Pass application is successful,a Letter of Approval from the Immigration Department of Malaysia will be sent to you. Only students who hold a valid Student Pass will bepermitted to enroll and commence classes.

Office use onlyFinance

Admissions Office

Future Students Office

Tracking No.

Student ID

Course code1Section A: Your application
1. Have you previously applied to Monash University or are you a MUFY student?

YesNoYes

NoYes

No

If yes, please state your Monash University ID No.:
2. Are you currently applying to / studying at another campus of Monash University?
If yes, please state your Monash University ID No.:
3. Have you changed your name since you last applied to / studied at Monash University?
If yes, please provide / attach relevant documentation.

Section B: Personal details
Please state name as per IC or passport. To avoid delays in your application, it is important you provide ALL relevant details clearly including youremail address.
Title (Mr, Ms, etc.):

Family name / Surname:

Given name(s):NRIC / Passport number:
Date of Birth*:

D D

Sex:
M M

M

FY Y Y Y*Note: Please refer to the Monash University age requirements for admissions at www.monash.edu.my/study/entry-requirements/age/

Nationality:

Postal address for correspondenceState:Country:

Postcode:

Telephone:

Fax:

Mobile:Email:(mandatory)(mandatory)

Home address (if this differs from the above postal address for correspondence)State:Country:

Postcode:

Telephone:

Fax:

Mobile:Email:(mandatory)

Monash registered agents
If you are applying through an agent, please ensure that your agent is registered with Monash University or you may experience delays in your application.
For details of registered agents in your country, please visit https://www.monash.edu/study/how-to-apply/international-student-applications/agents-database
Agency and branch:
Country:
Agent’s name:
Email:

Telephone:
Registeredagent’s
stamp:

2Section C: Student pass details (for international students only)
Have you previously applied to any educational institutions in Malaysia?
YesNo

If yes, which institution?

Please state your passport expiry date.

D D

M M

Y Y Y Y

Have you previously held or obtained a student pass approval from any educational institution in Malaysia?
YesNo

If yes, which institution?

Are you currently studying in Malaysia?

Yes

No

If yes, please state your pass type (eg. student, dependent)
When does this student pass expire?

D D

M M

Y Y Y Y

Please state the city and country where you will obtain your single-entry visa.
Note: Application for a single-entry visa should be made at the Malaysian Diplomatic Mission in your home country.
If there is no Malaysian Diplomatic Mission in your country, you may apply at one closest to you.

Section D: Course preferences
Choose up to 3 courses you would like to study and list them in order of preference.
Undergraduate Course title(please include your preferred field of study i.e. B.Eng in Mechanical)

Major

Commencing semester and year

1.

MonthYear

2.

MonthYear

3.

MonthYear

Note: Monash University reserves all rights in offering the courses available and their commencing semester, or alternative courses within the relevant study discipline.

Postgraduate (coursework)

Full time / Part time1.
2.

MonthYear

MonthYear(part time option not applicable for International students)

Section E: English language proficiency
All applicants must meet the University’s English language proficiency requirements. You must provide proof ofEnglish proficiency to the required standards of your chosen course. There are number of ways to satisfy theserequirements. For details, visit http://www.monash.edu.my/study/entry-requirements/english.
Have you completed at least six years of schooling in an English medium institution in an English-speaking country prior to the age of 19?
Yes

No

IELTS / TOEFL / PTE:
If you have not yet sat an IELTS / TOEFL exam please indicate the following details:
I will sit / have sat for an English language proficiency test
Date: D D

M M

IELTS

TOEFL

PTE

Y Y Y YIf you do not meet the English language requirements, you may be eligible for Monash English Bridging (MEB). If youwish to join MEB, please include the program under Section D: Course Preferences. For more details, please visit
https://www.monash.edu.my/study/entry-requirements/english/bridging-program3

Section F: Academic qualifications and other required documents* Please submit certified true copies of relevant academic transcripts / results for ALL qualifications / academic studies, either currently enrolled, completed or discontinued, including failures (if any).
If the qualifications are in languages other than English, please also supply certified translated copies. The documents must be certified by your current or previous education institution;a Monash University registered representative or agent; a Monash University staff member; a solicitor; or a commissioner for declaration. Monash University Malaysia reserves
the right to refuse documentation on the grounds of incorrect certification or translation procedures.

Secondary Studies
Year 11 or equivalent (eg. O-Level / SPM)
Qualification:
Institution:
State
Date commenced:

Country:
D D

M M

Date completed:Y Y Y YD D

M M

Y Y Y Y

Date completed:

D D

M M

Y Y Y Y

Available date of results:

D D

M M

Y Y Y Y

Date completed:

D D

M M

Y Y Y YAvailable date of results:

D D

M M

Y Y Y Y

Date completed:

D D

M M

Y Y Y Y

Available date of results:

D DM MY Y Y YYear 12 or equivalent (eg. MUFY / A-Level / STPM / Pre-U)
Qualification:
Institution:
State
Date commenced:

Country:
D D

M M

Currently awaiting results:

Y Y Y Y
Yes

No

Tertiary Studies(if applicable) Please list your most recent qualification first.

Diploma / Bachelor or equivalent
Degree / Qualification:
Field of study / Specialisation:
Institution:
State:
Date commenced:

Country:
D D

M M

Currently awaiting results:

Y Y Y Y
Yes

NoOthers
Degree / Qualification:
Field of study / Specialisation:
Institution:
State:
Date commenced:

Country:
D D

Currently awaiting results:

M M

Y Y Y Y
Yes

No

*Documents submitted with your application remain the property of Monash University

4Section G: Employment history (for postgraduate applicants only)
Please provide details of any employment experience that may be relevant to the courses applied. Supporting documentation; ie. CV or referencesmust be submitted. Please attach additional pages if space below is insufficient.
Occupation:
Start date:

Position:
D D

M M

Employment type:Y Y Y Y

End date:

Full-time

D DM MY Y Y Y

Organisation:

Part-time
Duties:Section H: Aptitude test (for Bachelor of Medical Science and Doctor of Medicine applicants only)
I will sit / have sat for ISAT aptitude test (this is a requirement for entry).
Date scheduled / taken:

D D

M M

Y Y Y Y
(result certificate required)

Result (if known):

ISAT candidate ID:

Section I: Credit transfer
If you request a credit transfer, please fill out the Credit Application Form and include relevant information on your previous or current course(eg. syllabus(es) / curriculum). Further information may be requested if your previous course has not been assessed by Monash University.

Do you wish to apply for credit transfer from previous study?

Yes

NoFor additional information, visit http://www.monash.edu.my/study/apply/credit-transfers

Section J: Scholarship / Sponsorship information
Have you applied for a scholarship / sponsorship from an organisation external to Monash University to support
your studies?
NoYes

If yes, please state the name of the external scholarship / sponsorship:What is the status of your external scholarship / sponsorship application?
Approved

Pending

Not approved

If the external scholarship / sponsorship has been approved, please provide a copy of the official letter with this application.

Section K: Students with disabilities
Do you have a disability, or ongoing medical condition which may affect your studies?

Yes

No

If yes, our Disability Services Unit at Monash University Malaysia may contact you to discuss the support services available. Your privacy will be maintained and the information provided will not be used
to disadvantage you. Monash promotes access and equity for students who have a disability or ongoing medical or mental health condition.

5Section L: Important checklist
A. For ALL applicantsApplication form filled out in full and signed
Application fee of RM100, USD38 or AUD35 (non refundable)
Certified copy of scholarship / sponsorship letter (if applicable)
One photocopy of NRIC (for Malaysians ONLY)
One photocopy of passport’s info page and visa page (for MM2H holder / PR) with passport validity of 14 months from the expected dateof entry (for International applicants ONLY)
Note: It is highly recommended that the passport be valid for the minimum duration of course. If the passport is expiring within 1 year from the time an application is to be accepted,
please apply for a new passport and submit photocopies of ALL pages of both passports.

A certified true copy of academic transcript / result for Year 11 or equivalent (not applicable for Postgraduate applicants)
A certified true copy of academic transcript / result for Year 12 or equivalent (not applicable for Postgraduate applicants)
Certified true copies of relevant academic transcripts / results for Diploma / Bachelor or equivalent
Proof of English language proficiency test (if applicable)
Signed credit transfer application (if applicable)
A copy of relevant syllabus(es) and academic grading scales (for credit transfer only)
Affidavits confirming identity (for applicants with names spelt differently in passport, certificates and other official documents)
Note: Affidavits must be issued by legal advisor

B. Additional documents required depending on your country of citizenshipCountry

Additional Documents Required
Please contact the respective Embassy for your requestIran

Letter of Eligibility (LOE)

Oman

No Objection Letter (NOL)

Sudan

No Objection Certificate (NOC)

C. For Bachelor of Medical Science and Doctor of Medicine applicants
A copy of International Student Admission Test (ISAT) result

6Section M: Privacy statement and declaration
Privacy Statement
The protection of personal data is important to Monash University Malaysia. Any personal data collected on this form will be treated in accordance with the Personal Data Protection
Notice of Monash University Malaysia accessible via www.monash.edu.myNotis Persendirian
Kenyataan Privasi
Perlindungan data peribadi adalah penting untuk Monash University Malaysia. Data peribadi yang dikumpul melalui borang ini akan diperlakukan mengikut Notis Perlindungan DataPeribadi Monash University Malaysia yang boleh diakses melalui www.monash.edu.myDeclaration
I have read the Personal Data Protection Notice provided by Monash University Malaysia pursuant to Section 7 of the Personal Data Protection Act 2010 accessible via
www.monash.edu.my, which includes the purposes for which my personal data is collected / processed and classes of third parties to whom Monash University Malaysia maydisclose my personal data.
I hereby give consent to Monash University Malaysia to process my personal data in accordance with the Personal Data Protection Notice.
I warrant that the information on this form, or provided in support of my application, is correct and complete. I acknowledge that the provision of incorrect information or the withholdingof relevant information relating to my application, including academic transcript(s), might invalidate my application and that Monash University may withdraw an offer or a placeor cancel my enrollment in consequence thereof. Should Monash University determine that I have submitted a false document, I consent to Monash University disclosing thisinformation to other relevant tertiary institutions.
I consent to any educational institution at which I have previously been a student and/or my current or any past employer, providing Monash University with information which that
institution or employer holds about me for the purpose of Monash University verifying my grades and/or qualifications and experience.
I agree to abide by the statutes, regulations and policies of Monash University at all times. I have read and understood the above conditions, and agree, authorise and accept them fully.

Deklarasi
Saya telah membaca Notis Perlindungan Data Peribadi yang disediakan oleh Monash University Malaysia menurut Seksyen 7, Akta Perlindungan Data Peribadi 2010 yang boleh
diakses melalui www.monash.edu.my yang merangkumi tujuan data peribadi saya dikumpul / diproses dan pihak-pihak ketiga kepada sesiapa Monash University Malaysia bolehmendedahkan data peribadi saya.
Saya dengan ini memberi kebenaran kepada Monash University Malaysia untuk memproses data peribadi saya mengikut Notis Perlindungan Data Peribadi.
Saya menjamin bahawa maklumat di dalam borang ini, atau yang saya berikan untuk menyokong permohonan ini, adalah benar dan lengkap. Saya mengakui bahawa pemberian
maklumat yang tidak benar atau penahanan maklumat yang relevan berkenaan dengan permohonan saya, termasuk transkrip akademik, mungkin akan membatalkan
permohonan saya dan bahawa Monash University boleh menarik balik suatu tawaran atau suatu tempat atau membatalkan pendaftaran saya sebagai akibat tersebut. Sekiranya
Monash University memutuskan bahawa saya telah menyerahkan suatu dokumen palsu, saya memberikan keizinan kepada Monash University untuk mendedahkan maklumat ini
kepada institusi-institusi pengajian tinggi lain yang relevan.
Saya memberikan keizinan kepada mana-mana institusi pendidikan di mana saya sebelum ini merupakan seorang pelajar dan/atau majikan saya kini atau sebelum ini, untuk
memberikan Monash University maklumat yang institusi atau majikan tersebut mempunyai tentang saya untuk tujuan Monash University mengesahkan gred-gred dan/atau
kelayakan saya dan pengalaman saya.
Saya bersetuju untuk mematuhi undang-undang, peraturan-peraturan dan polisi-polisi Monash University pada semua masa. Saya telah membaca dan memahami syarat-syarat
di atas, dan bersetuju, memberi kebenaran dan menerima syarat-syarat tersebut sepenuh.

Applicant’s signature:

Date:

D D

M M

Y Y Y YIf you are under 18 years of age at the time of submitting this application you must have a parent or guardian sign thisdeclaration on your behalf:

Parent / guardian signature:

Date:

D D

M M

Y Y Y Y

Parent or guardian contact details:
Name of parent / guardian:

Parent / guardian’s MyKad no. (for Malaysians) / passport no (for International applicants):

Parent / guardian’s email:

Where the context permits, references to “Monash University” herein this application form means Monash University Malaysia Sdn. Bhd. (Co. No. 458601-U) and/or Monash University (ABN 12 377 614 012).
Di mana konteks membenarkan, rujukan-rujukan kepada “Monash University” di dalam borang permohonan ini bermakna Monash University Malaysia Sdn. Bhd. (No. Syarikat 458601-U) dan/atau Monash University (ABN 12 377 614 012).

7

Office use only
Student Name:
Student ID:
Offer with conditions

Offer of admission

Conditional offer

Additional comments (if any):

Offer conditions - please state:

Offer authorised by:

Conditional offer authorised by:

D D

Date:

M M

Date:

Y Y Y Y

Rejection − No offer

D D

M M

Y Y Y Y

Offer Conditions Met

Reason for rejection − tick appropriate box

Yes

Authorised by:

Insufficient quota
Documentation unsatisfactoryDate:

Not qualified
Rejection authorised by:
Date:

D D

M M

Y Y Y Y

Remarks:

Contact us
Business hours are from Mondays to Fridays 8.30am – 6pm
Counselling hours for course enquiries are
8.30am – 5.30pm from Mondays to Fridays
Closed on weekends and public holidays

Enquiries
Telephone:
Facsimile:+60 3 5514 6000
+60 3 5514 6001

EmailCourses: mum.enquiry@monash.edu
Admissions: mum.admissions@monash.edu

Address
Monash University Malaysia
Jalan Lagoon Selatan
47500 Bandar Sunway
Selangor Darul Ehsan
Malaysiamonash.edu.myDULN002(B) Co. No. 458601-U (Date of establishment: 20 March 2000)

March 2022
8D DM MY Y Y YNo