CENTRE FOR GRADUATE STUDIES DEPARTMENT OF ACADEMIC AFFAIRS UNIVERSITI UTARA MALAYSIA

To all applicants Graduate Studies Programme Universiti Utara Malaysia Thank you for choosing Universiti Utara Malaysia as your centre for excellence. Kindly please take in to consideration all the matters listed below while filling in the form :   Please 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 following must be submitted together with complete Application Form :
Payment slip of the processing fee of RM50.00 for Malaysian applicants. Recepted Bill Payment Slip (BPS) for amount RM50.00 for processing fee which can be paid at any branch of BANK ISLAM MALYSIA BERHAD (BIBM) by using BPS Stating “Payee Code340”.

Certified copies of Malaysian Education Certificate (MCE), Degree/equivalent qualifications Malaysian
University English Test (MUET) / Teaching English as a Foreign Language (TOEFL) / International English Language Testing System (IELTS), professional certificates and full Academics Transcripts. Applicants in

their final semester of first degree must attach certified copies of result for every semester); Scholarship/training award/study loan certification letters; Letter of approval/official leave from employer/relevant authorities to pursue this programme;
Copy of research proposal (for applicants doing full research only);

Foreign Applicants are requested to send four (4) copies of every page of the international passport and six (6) copies of passport sized colour photos for the student pass application process;
Please take note that the status of form acceptance and your application will be notified through e-mail. Kindly please ensure the column is clearly filled in as to ensure you will get the latest information from the Centre for Graduate Studies. Only complete forms and received before or on the closing date will be processed. Application forms received beyond the date mentioned will be considered for the coming semester. Please address your application to : Director Centre for Graduate Studies Department of Academic Affairs Universiti Utara Malaysia 06010 Sintok Kedah Malaysia (ATTN: FARHANA ABDUL WAHAB)

I look forward to seeing you at UUM. Thank you.

FARHANA ABDUL WAHAB for Director Centre for Graduate Studies

PUSAT PENGAJIAN SISWAZAH JABATAN HAL EHWAL AKADEMIK UNIVERSITI UTARA MALAYSIA

Kepada Semua Pemohon Program Pengajian Siswazah Universiti Utara Malaysia Terima kasih kerana memilih Universiti Utara Malaysia sebagai pusat kecemerlangan anda. Sukacita sekiranya tuan/puan dapat mengambil perhatian mengenai perkara-perkara berikut semasa mengisi borang permohonan :   Sila isi borang permohonan dengan huruf blok dan menggunakan pen hitam atau ditaip; Sila isi semua bahagian. Tulis ‘Tiada” di mana tidak berkenaan;

Sila kemukakan perkara-perkara berikut bersama borang permohonan yang telah lengkap diisi: Slip bayaran wang proses sebanyak RM 50.00 bagi pemohon warganegara Malaysia. Sila kreditkan bayaran berkenaan atas nama Bendahari UUM, di mana-mana cawangan Bank Islam salinan Sijil Pelajaran Malaysia (SPM), Ijazah/kelulusan setaraf, Malaysian University English Test (MUET) / Teaching English as a Foreign Language (TOEFL) / International English Language Testing System (IELTS), sijil kelulusan professional dan Transkrip Akademik lengkap yang telah disahkan. Pemohon di dalam semester akhir pengajian dikehendaki mengemukakan salinan sah keputusan peperiksaan setiap semester; surat pengesahan biasiswa /hadiah latihan/pinjaman pengajian; surat kelulusan/pelepasan majikan/pihak berkuasa berkenaan untuk mengikuti program ini ; salinan kertas cadangan penyelidikan (bagi program secara penyelidikan sahaja); Bagi calon luar negara sila sertakan empat (4) salinan setiap mukasurat pasport antarabangsa serta enam (6) keping gambar berukuran pasport untuk urusan permohonan pas pelajar. Sila ambil perhatian bahawa status penerimaan borang dan permohonan tuan/puan akan dimaklumkan melalui e-mel. Sila pastikan ruangan yang berkenaan diisi bagi membolehkan tuan/puan mengetahui maklumat terkini. Hanya permohonan yang lengkap dan diterima sebelum atau pada tarikh tutup permohonan sahaja yang akan dipertimbangkan. Permohonan yang diterima selepas tarikh tutup akan dipertimbangkan bagi sesi kemasukan berikutnya/.Sila alamatkan permohonan anda kepada alamat seperti berikut : Pengarah Pusat Pengajian Siswazah Jabatan Hal Ehwal Akademik Universiti Utara Malaysia 06010 Sintok Kedah Malaysia (U.P: FARHANA ABDUL WAHAB)

Jumpa anda di UUM. Terima kasih

FARHANA ABDUL WAHAB b.p Pengarah Pusat Pengajian Siswazah

UNIVERSITI UTARA MALAYSIA
PERMOHONAN MENGIKUTI PENGAJIAN SISWAZAH
(APPLICATION FOR GRADUATE ADMISSION) Semester/Semester Sesi/Session

Lekatkan Gambar Terbaru (Recent Photograph)

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BUTIRAN PROGRAM (Programme details) Nama Program (nyatakan satu sahaja) : (Name of Programme [state one only]) Fakulti : (Faculty) MASTER OF BUSINESS ADMINISTRATION

FAKULTI PENGURUSAN PERNIAGAAN

Bentuk Pengajian* : [ (Mode of Studies)

] Penuh Masa (Full- time)

[ X ] Sambilan (Part-time) [ X ] Kerja Kursus [ (By Coursework)

[ ] Jarak Jauh (Distance Learning) ] Kerja Kursus & Penyelidikan (By Coursework & Research)

Struktur Program : [ ] Penyelidikan (Programme Structure) (By Research) Tempat Pengajian : (Place of Studies)

UUM KULIM CAMPUS (D-MEN RESOURCES SDN BHD)

2

BUTIRAN PERIBADI (Personal Details) Nama Penuh : _____________________________________________________________________ (Full Name) No. Kad Pengenalan : ________________________ (Identity Card No.) Tarikh Lahir : _______________________________ (Date of Birth) Jantina : (Gender) [ ] Lelaki (Male) [ ] Perempuan (Female) No. Pasport : ________________________ (Passport No.) Tempat lahir : ________________________ (Place of Birth) Umur : ______________________________ (Age)

Agama: _____________ (Religion) Taraf Perkahwinan : (Marital Status)

Bangsa : _____________ Warganegara: _______________________ (Race) (Nationality) [ ] Bujang (Single) [ ] Berkahwin (Married) [ ] Duda/Janda (Widow)

Alamat Surat Menyurat (Mailing Address ) :

Alamat Tetap (Permanent Address) :

Poskod : __________ Bandar : ______________ (Postcode) (Town) Negeri: ___________ Negara : ______________ (State) (Country)

Poskod : __________ Bandar : ______________ (Postcode) (Town) Negeri: ___________ Negara : ______________ (State) (Country)

No.Tel : ____________ (Rumah) _____________ (Tel. Bimbit) E-mel : _____________________ (Tel. No.) (Home) (Mobile) (E-mail) * Nota : Sila tandakan ( X ) di mana yang berkenaan. Note : Please tick ( X ) whichever applicable.

Universiti Utara Malaysia

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LATAR BELAKANG KELUARGA (Family Background) a. Nama Suami/Isteri : ______________________________________________________________ (Name of Spouse) Pekerjaan : ______________________________ No. Tel : _______________________________ (Occupation) (Tel. No.) Nama & Alamat Majikan : _________________________________________________________ (Employer's Name & Address) _______________________________________________________________________________ No. Tel (Tel. No.) : ________________________ Bilangan Anak (No. of Children) : __________ b. Orang yang boleh dihubungi pada waktu kecemasan : _________________________________ (Person to be notified in case of emergency) Alamat (Address) :________________________________________________________________ _______________________________________________________________________________ No. Tel. (Tel. No.) : ________________________ Pertalian (Relationship) : _________________

4

BUTIRAN PEKERJAAN/PENGALAMAN (Employment Details/Experience) Jawatan Sekarang : _______________________________ Tarikh dipegang : ________________ (Present Position) (Date Held) Nama dan Alamat Majikan : _________________________________________________________ (Employer's Name and Address) _________________________________________________________________________________ No.Tel : ________________ No. Faks : ________________ E-mail : ________________________ (Tel. No.) (Fax No.) (E-mail)

Jawatan Dahulu (Pengalaman kerja selepas Ijazah pertama, jika ada) (Previous positions [Working experience after obtaining First Degree, if any]) Nama Jawatan (Name of Positions) Nama dan Alamat Majikan (Employer’s name and address) Dari – Hingga (From – To) Tempoh Bekerja (Length of Service)

Universiti Utara Malaysia

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LATAR BELAKANG AKADEMIK (Academic Background) Nama dan alamat Institusi (Name and address of Institution) Tahun Pengajian (Years Attended) Diploma/Degree Obtained (Diploma/Ijazah diperolehi) Tarikh Anugerah (Date Of Graduation)

Kelas/PMK (Class/CGPA)

6

KELAYAKAN PROFESIONAL (Professional Qualifications) Kelulusan (Qualification[s]) Tahun dianugerah (Year Awarded) Dianugerahkan oleh (Awarded by)

7

KEMAHIRAN BAHASA (Language Proficiency) Tahun Lulus (Year Passed)

Bahasa (Language) Melayu (Malay)

Nama Peperiksaan/Ujian (Name of Examination/Test) Sijil Pelajaran Malaysia* (Malaysian Certificate of Education*) Sijil Pelajaran Malaysia (Malaysian Certificate of Education*)

Gred (Grade)

Inggeris (English)

Malaysian University English Test (MUET)* Teaching English as a Foreign Language (TOEFL) International English Language Testing System (IELTS)

Lain-lain (Sila nyatakan) : ____________________________________________________________ Others (Please specify) * Untuk pemohon Malaysia sahaja (For Malaysian applicants only)

Universiti Utara Malaysia

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PENERBITAN PROFESIONAL (Professional Publications)

Tajuk Buku/Jurnal (Title of Book/Journal)

Tahun diterbitkan (Year of Publication)

Nama dan Tempat penerbitan (Name and location of Publication)

9

BANTUAN KEWANGAN (Financial Support) Sila nyatakan sumber bantuan kewangan anda (Please indicate your source of financial support) Saya dibiayai penuh oleh majikan /kerajaan Negara saya (I am fully sponsored by my employer / government) Saya dibiayai melalui tabung pinjaman pendidikan (I am sponsored by study loan fund) Saya seorang pelajar persendirian dibiayai oleh saya sendiri/keluarga saya (I am a private student supported by myself /my family) Nama dan alamat penaja atau organisasi yang akan membayar yuran pengajian anda (Name and address of person and organization paying your fees)

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PENYOKONG AKADEMIK [Namakan dua (2)] (Academic Referees) [Name two (2)] Penyokong akademik hendaklah terdiri daripada mereka yang mengenali calon dari segi kebolehan akademik (contoh : Dekan, Pensyarah, Majikan) dan bukan daripada kawan atau saudara mara sendiri. (The academic referees must comprise of those who know the applicant in terms of his/her academic performance [e.g. : Dean, Lecturer, Employer] and should not have any personal acquaintances or relatives)
1) Nama : _______________________________ (Name) Alamat : ______________________________ (Address) _______________________________________ ___________________________________ No. Tel. (Tel. No) : ______________________ Jawatan Hakiki : ________________________ (Official Position) 2) Nama :________________________________ (Name) Alamat : _____________________________ (Address) ______________________________________ ______________________________________ No. Tel. (Tel. No) : _____________________ Jawatan Hakiki : ______________________ (Official Position)

Universiti Utara Malaysia

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BIDANG PENYELIDIKAN (Field of Research) Pemohon yang ingin mengikuti program siswazah secara penyelidikan dikehendaki mengisi bahagian ini. (Applicants who wish to pursue graduate studies by full research must fill in this section) Bidang Penyelidikan : _____________________________________________________________ (Area of Research) Cadangan Tajuk Penyelidikan : ______________________________________________________ (Proposed Research Title) _________________________________________________________________________________ Tujuan/Objektif Penyelidikan : _______________________________________________________ (Aims/Objectives of Research) _________________________________________________________________________________ Staf Akademik yang ditemui untuk perbincangan mengenai penyelidikan, jika ada : (Academic Staff whom you have met and discuss about your research, if any) _________________________________________________________________________________ Cadangan tempat untuk menjalankan penyelidikan (Intended research location) _________________________________________________________________________________ SILA SERTAKAN SALINAN CADANGAN PENYELIDIKAN (PLEASE ATTACH A COPY OF YOUR RESEARCH PROPOSAL)

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PENGAKUAN (Declaration) Saya mengaku semua keterangan di atas dan dokumen yang diberikan adalah benar dan lengkap. Universiti Utara Malaysia berhak menolak permohonan ini sekiranya keterangan tersebut didapati palsu dan/atau tidak lengkap. (I hereby certify that the above information and documents enclosed are true and complete. Universiti Utara Malaysia reserves the right to reject this application if the information given is false and/or incomplete).

_______________________ Tarikh (Date)

____________________________ Tandatangan Pemohon (Applicant's Signature)

Sila hantar borang permohonan ini lengkap dengan dokumen yang berkenaan kepada : (Please send this application form complete with all the related documents to :)

PENGARAH PUSAT PENGAJIAN SISWAZAH JABATAN HAL EHWAL AKADEMIK UNIVERSITI UTARA MALAYSIA 06010 UUM SINTOK, KEDAH MALAYSIA

DIRECTOR CENTRE FOR GRADUATE STUDIES JABATAN HAL EHWAL AKADEMIK UNIVERSITI UTARA MALAYSIA 06010 UUM SINTOK, KEDAH MALAYSIA

LAPORAN PENYOKONG (Referee’s Report) Laporan ini adalah SULIT dan hendaklah dimeteri oleh penyokong sendiri dan diberikan kepada pemohon untuk dihantar bersama dengan borang permohonan. (This report is CONFIDENTIAL and must be sealed by the referees and forward the envelope to the applicant to be submitted together with the application form) BAHAGIAN A : UNTUK DIISI OLEH CALON (Part A : To be completed by the applicant) Nama : __________________________________________________________________________ (Name) Program Pengajian : MASTER OF BUSINESS ADMINISTRATION___________________________ (Programme of Studies) Tempat Pengajian : UUM KULIM CAMPUS (D-MEN RESOURCES SDN BHD)_________________ (Place of Studies) BENTUK PENGAJIAN* : [ (Mode of studies) STRUKTUR PROGRAM : [ (Programme Structure) ] Penuh Masa (Full- time) [ X ] Sambilan (Part-time) [ ] Jarak Jauh (Distance Learning) ] Kerja Kursus & Penyelidikan (By Coursework & Thesis)

] Penyelidikan [ X ] Kerja Kursus [ (By Research) (By Coursework)

BAHAGIAN B : UNTUK DIISI OLEH PENYOKONG (Part B : To be completed by the referee) Nama (Name) : _____________________________________________________________________ Jawatan Hakiki (Official Position) : _____________________________________________________ Nama dan Alamat Majikan: __________________________________________________________ (Employer’s name and address) ______________________________________________ Poskod (Postcode) : _________________ Bandar: _______________ (Town) Negeri : _______________ Negara : _________________________ (State) (Country)

No.Tel : ________________ No. Faks : ______________ E-mail : __________________________ (Tel. No.) (Fax No.) (E-mail)

BAHAGIAN C : LAPORAN PENYOKONG (Part C : Referee’s Report) a) Berapa lamakah anda mengenali pemohon? Bil. tahun ______________________ (How long have you known the applicant? No. of years) b) Bagaimana anda mengenali pemohon? (How do you know the applicant?)

* Sila tandakan ( X ) di mana yang berkenaan Please tick ( X ) whichever appropriate

c) Apakah pertalian di antara tuan dengan pemohon? ___________________________________ (What is your relationship to the applicant?) d) Adakah anda percaya pemohon bersedia untuk beban kerja pengajian Siswazah? (Do you believe that the applicant is prepared for graduate work?) [ ] Ya (Yes) [ ] Tidak (No)

e) Pada pendapat anda, apakah ciri-ciri keperibadian pemohon yang akan membolehkan beliau mengikuti pengajian Siswazah? (What do you think are personal traits of the applicant that will enable him/her to pursue graduate study?) _______________________________________________________________________________ _______________________________________________________________________________ f) Bagaimanakah anda menilai pemohon bagi perkara-perkara berikut? (Tandakan  ) (How do you rate the applicant on each of the following?) (Please tick  ) Cemerlang (Excellent) i) ii) Kebolehan intelek (Intellectual ability) Kematangan dan kestabilan emosi (Maturity and emotional stability) Amat Baik (Very Good) Baik (Good) Sederhana (Average) Lemah (Poor)

iii) Motivasi (Motivation) iv) Pengetahuan Am (General Knowledge) v) Inisiatif (Initiative)

vi) Kebolehan kerjasama (Ability to cooperate) vii) Tanggungjawab (Responsibility)

SOKONGAN ANDA (Your Recommendation)

[

] Disokong (Recommended)

[

] Tidak disokong (Not recommended)

______________________ Tarikh (Date)

_________________________ Tandatangan Penyokong (Referee’s Signature)

LAPORAN PENYOKONG (Referee’s Report)

Laporan ini adalah SULIT dan hendaklah dimeteri oleh penyokong sendiri dan diberikan kepada pemohon untuk dihantar bersama dengan borang permohonan. (This report is CONFIDENTIAL and must be sealed by the referees and forward to the applicant to be submitted together with the application form) BAHAGIAN A : UNTUK DIISI OLEH CALON (Part A : To be completed by the applicant) Nama : __________________________________________________________________________ (Name) Program Pengajian : MASTER OF BUSINESS ADMINISTRATION___________________________ (Programme of Studies) Tempat Pengajian : UUM KULIM CAMPUS (D-MEN RESOURCES SDN BHD)_________________ (Place of Studies) BENTUK PENGAJIAN* : [ (Mode of studies) STRUKTUR PROGRAM : [ (Programme Structure) ] Penuh Masa (Full- time) [ X ] Sambilan (Part-time) [ ] Jarak Jauh (Distance Learning) ] Kerja Kursus & Tesis (By Coursework & Thesis)

] Penyelidikan [ X ] Kerja Kursus [ (By Research) (By Coursework)

BAHAGIAN B : UNTUK DIISI OLEH PENYOKONG (Part B : To be completed by the referee) Nama (Name) : _____________________________________________________________________ Jawatan Hakiki (Official Position) : _____________________________________________________ Nama dan Alamat Majikan: __________________________________________________________ (Employer’s name and address) ______________________________________________ Poskod (Postcode) : _________________ Bandar: _______________ (Town) Negeri : _______________ Negara : _________________________ (State) (Country)

No.Tel : ________________ No. Faks : ______________ E-mail : _________________________ (Tel. No.) (Fax No.) (E-mail)

BAHAGIAN C : LAPORAN PENYOKONG (Part C : Referee’s Report) a) Berapa lamakah anda mengenali pemohon? Bil. tahun ______________________ (How long have you known the applicant? No. of years) b) Bagaimana anda mengenali pemohon? (How do you know the applicant?)

* Sila tandakan ( X ) di mana yang berkenaan Please tick ( X ) whichever appropriate

c) Apakah pertalian di antara tuan dengan pemohon? __________________________________ (What is your relationship to the applicant?) d) Adakah anda percaya pemohon bersedia untuk beban kerja pengajian Siswazah? (Do you believe that the applicant is prepared for graduate work?) [ ] Ya (Yes) [ ] Tidak (No)

e) Pada pendapat anda, apakah ciri-ciri keperibadian pemohon yang akan membolehkan beliau mengikuti pengajian Siswazah? (What do you think are personal traits of the applicant that will enable him/her to pursue graduate study?) _______________________________________________________________________________ _______________________________________________________________________________ f) Bagaimanakah anda menilai pemohon bagi perkara-perkara berikut? (Tandakan  ) (How do you rate the applicant on each of the following?) (Please tick  )

Cemerlang (Excellent) i) ii) Kebolehan intelek (Intellectual ability) Kematangan dan kestabilan emosi (Maturity and emotional stability)

Amat Baik (Very Good)

Baik (Good)

Sederhana (Average)

Lemah (Poor)

iii) Motivasi (Motivation) iv) Pengetahuan Am (General Knowledge) v) Inisiatif (Initiative)

vi) Kebolehan kerjasama (Ability to cooperate) vii) Tanggungjawab (Responsibility)

SOKONGAN ANDA (Your Recommendation)

[

] Disokong (Recommended)

[

] Tidak disokong (Not recommended)

______________________ Tarikh (Date)

_________________________ Tandatangan Penyokong (Referee’s Signature)

PUSAT PENGAJIAN SISWAZAH UNIVERSITI UTARA MALAYSIA 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) Slip bayaran wang proses RM 50.00 bagi pemohon Malaysia, atau cek/bank draf/kiriman wang, dibayar atas nama “Bendahari UUM”. (Payment Slip of procesing fee of RM50 for Malaysian applicants or cheque/bankdraft/money order, payable to “Bendahari UUM”) Borang Permohonan yang lengkap diisi dan bertandatangan (Complete and signed application form) Dua (2) keping gambar dengan satunya dilekatkan di borang permohonan (Two (2) copies of recent photograph, and one is fixed to the application form). Sesalinan Sijil SPM, MUET/TOEFL/IELTS, Ijazah/kelulusan setaraf, sijil kelulusan profesional dan transkrip akademik lengkap yang telah disahkan. Salinan sah keputusan peperiksaan akhir bagi setiap semester (bagi pemohon dalam tahun akhir pengajian. (Certified copies of SPM certificate, MUET/TOEFL/IELTS, degree/equivalent qualifications, professional certificates and full academic transcipts. Certified copies of result for every semester for applicants in their final year) Dua (2) salinan borang sokongan daripada dua (2) orang penyokong (Two (2) copies of referee form from two (2) referees) Sesalinan kertas cadangan penyelidikan bagi pengajian secara penyelidikan sahaja. (Sarjana 1000 – 1500 patah perkataan, Doktor Falsafah 1500 – 2000 patah perkataan) (A copy of your research proposal for applicants doing full reseach only. [1,000 – 1,500 words for the masters, and 1500 – 2000 words for Ph.D]) Lima (5) salinan setiap mukasurat pasport antarabangsa serta tujuh (7) keping gambar berukuran pasport untuk urusan permohonan pas pelajar (bagi pemohon luar negara sahaja) (Five (5) copies of every page of the international passport and seven (7) copies of passport sized colour photos for the student pass application process (for international applicants only). Tandakan  (Tick)

1.

2.

3.

4.

5.

6.

7.

NAMA (NAME) PROGRAM (PROGRAMME) FAKULTI (FACULTY) TANDATANGAN (SIGNATURE) MASTER OF BUSINESS ADMINISTRATION

UUM KULIM CAMPUS (D-MEN RESOURCES SDN BHD)