SEGi Online Application Form

Online Application Form

1. Personal Information

I am a:

Malaysian Student

Non-Malaysian Student

First Name:

Last Name / Surname:

Date of Birth:

Identity Card No:

(Eg:870110065298)

Nationality:

Passport Number:

Gender:

Male

Female

Mobile No.:

(Eg:60129388829)

E-mail Address

2. Permanent Address

Address

City / Town:

Post Code:

State:

Country:

3. Academic Qualification

Secondary School Qualification:

Result:

Year of completion:

Institution / University Grade:

Year of completion:

Institution / University Grade:

Year of completion:

Institution / University:

Result:

Year of Completion:

Institution / University:

Result:

Year of Completion:

Institution / University:

Result:

Year of Completion:

4. English Qualification

MUET:

IELTS:

GCE O'Level:

TOEFL:

Others:

5. Work Experience (Applicable to postgraduate applicant)

Company:

Position:

Contact No.:

Working Experience (Year):

6. Programme Preferred 1

Programme Level / Study:

Faculty / School:

Programme Name:

Campus:

7. Programme Preferred 2

Programme Level / Study:

Faculty / School:

Programme Name:

Campus:

8. Programme Preferred 3

Programme Level / Study:

Faculty / School:

Programme Name:

Campus:

9. Declaration & Agreement by Applicant

I decare that the information provided by me in connection with the application is true and correct. I undertake to inform SEGi University immediately of any changes in address, phone number and any other information provided by me in this application. I understand that SEGi University reserves the right to vary or reverse any decision regarding admission or enrolment made on the basis of incorrect or imcomplete information. I agree to be bound by the Terms and Conditions of the offer to student at SEGi University .

10. Declaration by Parent / Guardian / Sponsor / (Applicable of applicants who are 21 and below)

Name of parent / guardian / sponsor:

Company:

Occupation:

Contact No:

E-mail Address

Address

City / Town:

Post Code:

State:

Country:

11. Verification

I allow SEGi University Group to contact me (your details will not be given to any third party)

I agree to SEGi University Group's Terms & Conditions and Privacy Policy