UTM STUDENT EXCHANGE PROGRAM APPLICATION FORM

444Before proceeding, please ensure you have these document ready as attachment in PDF/JPG.

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

Please submit your application for Semester I (October 2023/2024) no later than 30 June 2023.

Application is NOW OPEN. Please email globaleducation@utm.my for any enquiries.

Student Exchange Application Form

A. Applicant/Participant Personal Details

Full Name (same as passport) *

Citizenship *

Gender *

Mailing Address Line 1 *

Address Line 2 *

City *

ZIP/ Postal Code *

Country *

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 *

Current CGPA *

Level of Study *

Undergraduate

Master

Nature of Study *

Taught Course

Taught Course & Research

Research

C. Study Abroad Programmes

Status *

Semester for Exchange *

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

Supervisor Name *

Please specify name of host supervisor (if available)

Research Project

Specify research project if applicable

Transfer of Credit required? *

Yes

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.

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 *

Maximum upload size: 5.12MB

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

Student Status Letter *

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 *

Maximum upload size: 5.12MB

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

Passport Photo *

Maximum upload size: 5.12MB

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

Sponsorship Document (if applicable)

Maximum upload size: 5.12MB

Research Proposal

Maximum upload size: 5.12MB

Please attach your research proposal (Master and PhD)

Study Plan Essay *

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.