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FOR MASTER OF SCIENCE AND DOCTOR OF PHILOSOPHY(BY RESEARCH) APPLICATION ONLY 1.

Please describe your proposed research topic and submit a 3-4 page synopsis of your research proposal (in not more than 300 words). List your problem statement, research objectives, literature review and methodology (Please use a separate sheet). 2. Kindly indicate the name of any academic that you may have communicated in OUM who is willing to supervise your research project (optional)

APPLICATION FOR GRADUATE ADMISSION


(USE CAPITAL LETTERS) A. PLEASE RANK 1, 2, 3 YOUR PREFERRED PROGRAM:

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Doctor of Philosophy (Business Administration) * Doctor of Business Administration ** Doctor of Education ** Doctor of Philosophy (Education) * Doctor of Philosophy (Engineering) * Doctor of Philosophy (Information Technology) * Doctor of Philosophy (Science) * Master of Business Administration *** Master of Counselling *** Master of Occupational Safety and Health Risk Management *** Master of English Studies *** Master of Environment Science Management *** Master of Human Resource Management ***

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Master of Information Technology *** Master of Education Master of Instructional Design and Technology *** Master of Islamic Studies *** Master of Management *** Master of Nursing *** Master of Software Engineering *** Master of Project Management *** Master of Public Administration *** Master of Information Technology in Network Computing *** Postgraduate Diploma in Teaching ***

APPLICATION PROCEDURES
CHECKLIST

1. Please use black ballpoint pen in CAPITAL letters only. 2. All sections of the form must be completed and the declaration signed and dated. 3. Enclose 1(one) certified copy of Identity Card (IC)/Passport. 4. Enclose 1(one) certified copy of all academic certificates and transcripts. 5. Enclose a non-refundable application fee of RM50.00 (for Malaysian) or RM100 (for non-Malaysian) in the form of bank draft/money order/postal order made payable to UNITEM. 6. Proposal/Outline (for Structure 1 only)

Note:
* = Structure I (Degree By Research) ** = Structure II (Degree By Coursework and Research) *** = Structure III (Degree By Coursework)

STRUCTURE OF STUDY
For Master of Education only ()

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III

B. PERSONAL PARTICULARS
Full Name

Please send complete application to: Registrar Admission & Record Unit, Open University Malaysia METEOR HOUSE Jalan Tun Ismail, 50480 Kuala Lumpur, Malaysia.

Correspondence Address

State Tel No. House H/Phone E-mail Address

Country Office Fax No.

*Incomplete application will not be processed.

Postcode City/Town

EMPLOYMENT BACKGROUND
Permanent Address

Title of Job Position Held (Most recent first)


Postcode

Name of Organisation/ Company

Period (Months/Years)

City/Town State Tel No. House Country Nationality

NRIC No. New Passport No. Expiry Date Place of Birth Race Sex Male Female Date of Birth

Old

FINANCIAL SUPPORT How do you plan to support your graduate studies? Please Tick Personal finance
Marital Status Single Married

Scholarship

In case of emergency, please contact :

Correspondence Address

PROFICIENCY IN ENGLISH LANGUAGE Please tick the appropriate box


Postcode

Excellent Written Communication Verbal Communication

Very Good

Good

Satisfactory

Weak

City/Town State Tel No. House H/Phone Country Office

Foreign Students are requested to submit their IELTS or TOEFL scores: Name of Tests:............................................................................ Year Taken: ....................... Score: ...................... Please explain why you applied for the above graduate program? How can this program assist you in your career development?

EDUCATION BACKGROUND Name of University/College Diploma or Degree Awarded Year Graduated Specialisation

I hereby certify that the information provided in this application form is correct to the best of my knowledge

.................................................... Signature of Applicant

....................................... Date

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