Application for Outbound Mobility (No Financial Aid required)

This form is for UTM Student going abroad for outbound mobility program but does not require any financial aid from UTMi. It is compulsory for any UTM student going abroad to get approval from UTMi and HEMA before going abroad, even if no financial aid is required.

Application for UTM Student Mobility (No Financial Assistance required)

Personal Details

Applicant's Name *

Matrix No *

IC Number/Passport *

Mobile Number *

Email Address *

Nationality *

Next of Kin's name *

Next of Kin' Mobile number *

Academic and Mobility Details

Faculty * Faculty

Study Level

School (Program/Field of Study)

Academic Advisor/Supervisor's name

Academic Advisor/Supervisor's Mobile number

Academic Advisor/Supervisor's email

Mobility Details

Select Mobility Type * Select Mobility Type

Name of Program

Are you going in a group?

Yes

Start Date *

End Date *

Host University/Institution *

Country *

Students List

Student Name

Matrix Card

Email Address

Phone Number

Add Remove

Financing Details

How do you intend to finance your program? *

Self Sponsor

External SponsorExternal Sponsor

Attachment

Please attach offer/acceptance letter from host university (in PDF format) *

Maximum upload size: 5.12MB

Please attach sponsorship letter in PDF format (if any)

Maximum upload size: 5.12MB

Declaration *

I hereby declare that the details furnished above are true and correct to the best of my knowledge. I shall inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

Address

City

State/Province

Zip/Postal

Country

File Upload

Maximum upload size: 5.12MB