Tick [√] where applicable 请在有兴趣的课程[√] 打钩:
Electronic Equipment 电子设备Electrical Installation & Maintenance 机电装置与维修Aesthetic Therapy 美容服务Diploma In Hairdressing 美发文凭Diploma In Bakery & Pastry 烘焙文凭ST Wireman PW2 Course (Full Time) 单相电工执照课程PW2 （全日班)ST Wireman PW2 Course (Part Time) 单相电工执照课程PW2 （兼职班)Wireman Pw4 Competency Course – Full Time 三相电工执照课程PW4 (全日班)Wireman Pw4 Competency Course – Part Time 三相电工执照课程PW4 (兼职班)Digitalization Manufacturing Automation 工业数码自动化课程Precision, Mould, Tools & Die Programme 精密摸具，工具与零件课程PPA-PPT Programme 经验认证IBS-Digital Manufacturing In Construction 数码工业化建筑Plumbing Technology Programme 水力工程技术课程
Intake applied for Year
Month of Intake:
Name 姓名*:
Age 年龄*:
Marital Status婚姻状况:
Single 单身Married 已婚Divorced 离婚
Gender 性别:
Male 男Female女
NRIC 身份证号码*:
Email 电邮地址*:
Mailing Address通讯地址*:
Handphone No.手机电话*:
Home phone No.住家电话*:
Please list all School / College / Qualifications that you have taken. 请选择您的学历资格和列出您所读的学校/学院*:
Father/Guardian’s Name 父亲/监护人名字*:
Occupation 职业:
Handphone No.手机电话:
Home Phone No. 住家电话:
Email 电邮地址:
Mother’s Name 母亲名字:
NRIC 身份证号码:
Mailing Address 通讯地址:
Relationship 关系*:
Handphone No. 手机电话*:
Home Phone No. 住家电话*:
Name 姓名:
Relationship 关系:
Handphone No. 手机电话:
1 certified copy of all relevant academic qualifications / examinations 一张学历资格 / 考试文凭副本(file size not exceed 1mb):
1 copy of School Leaving Certificate 一张毕业证书副本(file size not exceed 1mb):
1 copy of Identity Card Copy一张身份证副本(file size not exceed 1mb):
3 passport size photos 三护照尺寸照片(file size not exceed 1mb):
Do you have any disability / serious illness which requires our attention? 你有否残疾/疾病？*:
Yes 是No 否
If yes, please specific or tick the relevant box, please provide relevant medical documentation upon this application. Disclosure of this information is treated confidentially and not be used to disadvantage 如果有的话， 请注明或勾选相关方框，请在申请时提供相关医疗证明。此信息的披露将受到保密处理，不会被用来造成不利影响。:
A specific learning disabilities such as dyslexia, dysgraphia, dyscalculia, dyspraxia and ect 特定的学习障碍，例如阅读障碍，书写障碍，计算障碍，动作协调障碍等Attention-Deficit Hyperactivity Disorder (ADHD) 注意缺陷多动障碍Autism Spectrum Disorder 自闭症类群障碍Epilepsy 癫痫Diabetes 糖尿病Asthma 哮喘Blind or Colour Blindness 失明或色盲Deaf or a serious hearing impairment 耳聋或严重听力障碍Along-term/ongoing mental health condition such as bipolar disorder, obsessive compulsive disorder, depression, an anxiety disorder or schizophrenia 长期/持续的精神健康状况，例如躁郁症，强逼症，忧郁症，焦虑症A physical impairment or mobility issue, such as difficulty using arms or hands, or requiring use of a wheel chair crutches or other mobility aid, cerebral Palsy, etc 身体障碍或行动问题，例如使用手臂或手部困难，或需要使用轮椅，拐杖或其他辅助工具，脑残等Others 其它
How did you know about us? 如何知道本学院?*:
Advertisement 广告Education Fair 教育展Banner / Leaflet 布条/传单Telemarketing 电话行销Friends / Introducer 朋友/介绍人-姓名Others 其它
Do you need financial assistance? 您需要贷学金吗?*:
Additional Information: Monthly Household Income 其他信息：家庭月收入*:
RM4,850 or below (B40) RM4,850或一下(B40)Between RM4,851 & RM10,970 (M40) 介于RM4,851 & RM10,970之间(M40)More than RM10,971 (T40) 超过RM10,971(T40)
IMPORTANT: Students are advised to read carefully and understand fully the terms and conditions set out in Section 9 before submit of this application form. 重要提示：建议学生在提交本申请表之前仔细阅读并充分理解第 9节中规定的条款和条件。 I hereby declare that the information provided and documents submitted in connection with this application are true and correct. I fully understand that: 本人谨此声明， 所提供的资料和提交的文件是真实及正确。我完全明白： 1. All fees paid are NOT refundable except for the deposit. 所有已缴纳的费用均不予退还除了定金。 2. All fees paid are NOT transferable to another new intake or enroll in another programme. 所有支付的费用均不可转移至其他新入学或注册其他课程。 3. In the event that student is expelled / suspended / withdrawal or discontinues the programme due to misconducts, student is liable to pay all fees and all fee paid are NOT refundable. 如果学生因不当行为而被开除/停学/退学或中止课程，学生有责任支付所有费用，且所有费用均不予退还。 4. Tuition fees should be paid as per student bill due date. Payment of tuition fees from the due date as stated on the student bill will be charged a penalty of RM10/day until the payment is made. Failure to pay fees on time, VTAR has the right to bar the student from attending class, examination and termination of study. 学费应按学生账单截至日期前缴纳。 从学生账单上注明的截止日期后支付学费将被收取每天 RM10 的罚款，直到付款为止。 未如按时缴纳费用的，拉曼技职学院有权禁止学生来上课、考试、包括终止学业。 5. The deposit may only be refunded after a student has completed or withdrawn from his/her last course of study at the Institute. The application in writing for the refund should be made within one year from the date of completion or withdrawal from the Institute. In the event that the student fail/neglect/did not claim or apply for refund of the deposit within the stipulated period of one year from the date of completion or withdrawal from the Institute, the deposit will be transferred and donated to the VTAR Institute Student Fund without further notice. 定金只有在学生完成或退出学院最后一门课程后才能退还。 退款申请应自结业或退学之日起一年内提出。 如果学生在完成学业或退学之日起一年内未能/疏忽/未索取或申请退还押金，则押金将被转移并捐赠给拉曼技职学院学生 基金并不另行通知。 6. I must abide by and comply with all the rules, regulations, policy and instructions of VTAR Institute. Including the rules and regulation of the respective department during my programme of study at VTAR. 我同意遵守拉曼技职学院所有的规则ˎ 规章和指示。包括我在VTAR学习期间各部门的规章制度。 7. There are NO deferrals are allowed for any programme at VTAR Institute. 拉曼技职学院的任何课程均不允许延期。 8. I agree and giving fully authority to VTAR Institute the right to use and processing of my personal data contained in this form, academic record, image, and spoken and written record of my activities at VTAR, in poster, leaflet, brochures, advertisement, website, films, video, electronic recordings and the like for marketing and promotion and publicity usage. 我同意并充分授权 VTAR 学院使用和处理本表格中包含的我的个人数据、学术记录、图像以及我在 VTAR 的活动的口头和书面记录、海报、传单、小册子、广告 、网站、电影、视频、电子录音等用于营销、促销和宣传用途和/或任何附带目的。 9. VTAR Institute reserves the right to change the Institute’s policies, programmes and fees at its discretion without prior notice. 拉曼技职学院有权修改学院的政策ˎ 方案和费用， 并无须在事先通知。
Declaration 声明*:
I hereby declare that the information provided and documents submitted in connection with this application are true and correct. 本人谨此声明， 所提供的资料和提交的文件是真实及正确。
