Student Exchange Application Form (Special)

Before proceeding please ensure you have these document ready as attachment in PDF/JPG.

1. Passport size photos (blue background)
2. A recommendation Letter from student`s Academic Advisor/home institution supporting their application
3. A status letter from student’s home institution with this FORMAT OF STATUS LETTER.
4. If the student is sponsored, state the details of sponsorship such as the name of sponsor, duration of sponsorship and value of sponsorship
5. An up-to date certified academic transcript (in English translation)

Please submit application no later than :

For 1st/Fall Semester (begin September) admission : 30th April
For 2nd/Spring Semester (begin February) admission : 30th Septermber

Student Exchange Application Form

A. Applicant/Participant Personal Details

Full Name (same as passport) *

Citizenship * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d‘Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe

Gender * Male Female

Mailing Address Line 1 *

Address Line 2 *

City *

ZIP/ Postal Code *

Country * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d‘Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe

Date of Birth *

Mobile Phone Number *

International format

Email *

Status *

Married

Single

Religion *

Passport Number *

B. Education Background

Home Institution/University *

Website

Paste URL here.

Home Faculty *

Programme Name *

Chemical Engineering, English, Business, Chemistry, Psychology etc.

Expected Year of Graduation *

Current Semester * First Second Third Fourth Fifth Sixth Seventh Eighth

Current CGPA *

Level of Study *

Undergraduate

Master

Nature of Study *

Taught Course

Taught Course & Research

Research

C. Study Abroad Programmes

Status * Undergraduate Postgraduate

Semester for Exchange * Semester II (March 2022/2023)

Please click if pursuing one year exchange

Proposed Courses to be taken in UTM

Subject/Course *

Code *

Credit *

Add Remove

Course/Subject Selection

Subject: Introduction to Biomedical Eng
Code : SMBE1012
Credit : 2

Please click the + button to add more subjects/courses

Please only choose courses corresponding to the semester. If you are studying in UTM in Semester 2, please choose only courses available in semester 2,4,6 and 8.

Proposed Start Date

Proposed End Date

English Speaking Proficiency *

Very Good

Good

Poor

Very poor

English Reading Proficiency *

Very Good

Good

Poor

Very poor

English Writing Proficiency *

Very Good

Good

Poor

Very poor

Host Faculty Faculty of Chemical and Energy Engineering (FKT) Faculty of Electrical Engineering (FKE) Faculty of Civil Engineering (FKA) Faculty of Mechanical Engineering (FKM) Faculty of Computing (FC) Faculty of Management (FM) Faculty of Science (FS) Faculty of Built Environment & Surveying (FABU) Faculty of Social Sciences and Humanities (FSSH) Azman Hashim International Business School (AHIBS) UTM-KL Branch Razak Faculty of Technology and Informatics (FTIR)UTM -KL Branch Malaysian- Japan International Institute of Technology (MJIIT) UTM-KL Branch

Supervisor Name *

Please specify name of host supervisor (if available)

Research Project

Specify research project if applicable

Transfer of Credit required? *

Yes

No

D. Finance

Sponsorship *

Self-sponsored

Home Institution

Indonesia International Student Mobility Award (IISMA)

OtherOther

E. Accomodation

Please be informed that we can provide on-campus accommodation upon request and is SUBJECT TO AVAILABILITY. Please choose room type for booking. Range for rate for single room : RM20/day/person to RM50/day/person. Room rate may vary depending on residential college. The basic room type is single/ twin room, ceiling fan, share bathroom with the room rate RM20/ day.

Type of accommodation *

On-campus

Off-campus

UTM International will make accommodation arrangement if you choose stay on-campus and students are responsible to arrange on their own if they choose off-campus accommodation.

Interested to stay with Host/Foster Family in Malaysia?

Yes

No

More information about host families is available at https://international.utm.my/keluargaangkat

F. Inter-office Communication

Please provide the contact details of the person from your university who is responsible to assist you in this program ( international affairs officer/student exchange coordinator).

Name of Officer in charge (International Office) *

Office/Department *

International Office of Your University Address Line 1 *

Address Line 2

City *

ZIP / Postal Code *

Phone number *

International format

Email (International office) *

G. Attachment and Declaration

Recommendation Letter *

Drop a file here or click to upload Choose File

Maximum upload size: 5.12MB

Recommendation letter from student's Academic Advisor/Home Institution supporting their application

Student Status Letter *

Drop a file here or click to upload Choose File

Maximum upload size: 5.12MB

Letter from Home University that state's the student has student status and covers the following details: current semester, active/inactive and expected graduation year.

Academic Transcript *

Drop a file here or click to upload Choose File

Maximum upload size: 5.12MB

An up-to-date certified academic transcript (translated to English)

Passport Photo *

Drop a file here or click to upload Choose File

Maximum upload size: 5.12MB

Passport-sized photos (white background only) in jpg. format

Sponsorship Document (if applicable)

Drop a file here or click to upload Choose File

Maximum upload size: 5.12MB

Research Proposal

Drop a file here or click to upload Choose File

Maximum upload size: 5.12MB

Please attach your research proposal (Master and PhD)

Study Plan Essay *

Drop a file here or click to upload Choose File

Maximum upload size: 5.12MB

A one page essay to describe your plans and expectations for this program.

Once the application has been approved, UTM International will issue an offer letter for the program. You will need to provide a copy of your passport and travel/medical insurance certificate.

For students coming for more than six (6) months, you will need to provide a copy of your medical report.

Checkboxes *

I hereby declare that the information provided in this form is true. I acknowledge that Universiti Teknologi Malaysia reserves the right to vary or reserve any decision regarding admission or enrolment made on the basis of the given information.

If you are human, leave this field blank.