APPLICATION FORM for Sungai Buloh campus

NAME OF STUDENT:       GENDER:  
First Name:    
Middle Name:    
Last Name:      
               
DATE OF BIRTH:      
CITIZENSHIP:      
RACE: (Malaysian Only) Chinese Indian Other    
               
NAME OF PARENT:            
Father:        
Mother:        
CITIZENSHIP OF PARENT:            
Father:        
Mother:        
OCCUPATION SECTOR:            
Father:        
Mother:        
OCCUPATION POSITION:            
Father:        
Mother:        
               
HOME ADDRESS:      
Postcode:        
CONTACT DETAILS:            
Home Tel:        
Office Tel:        

Mobile Tel:

       
Email:        
             
NO. OF CHILDREN IN FAMILY:          
               
SIBLINGS (applying to / currently in elc)      
Name:
Year:
Date Of Birth:
Name:
Year:
Date Of Birth:
Name:
Year:
Date Of Birth:
               
STUDENT'S CURRENT SCHOOL: Location of current school:
(state country only)
Student's Current Year/Level:          
               
SEEKING ADMISSION FOR:        
Year:        


   
               
FORM COMPLETED BY:            
Name:          
Date: