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ADMISSIONS & RECORDS DIVISION,IIUM, JALAN GOMBAK, 53100 KUALA LUMPURTel: 603-6196 4045 / 4043 / 3024 / 3261 Fax: 603-6196 4724 / 4160

E-Mail: [email protected] Website: hp://www.iium.edu.my/anr

Admission BookletFor International Undergraduate

Programme 2011/2012INTERNATIONAL ISLAMIC UNIVE RSITY MALAYSIA

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PageAdmissions & Records Division

INTERNATIONAL ISLAMIC UNIVERSITY M ALAYSIA

Admission Booklet

No. Particular Page

1. Offer Leer

2. Admission Booklet 3-8

3. Order of Aire for Students 9-12

4. Student Discipline Rules Please refer to:www.iiu.edu.my/rector/legal/

5. Appendix A 13-15 TUITION FEE AND OTHER RELATED ADMINISTRATIVE FEES

6. Appendix B 16-18 TERMS AND CONDITIONS OF OFFER AND ENROLMENT

7. Appendix C 19-29 ALL RELATED FORMS

2

* Admissions & Records Division

March 2011

Admission ChecklistFor International Undergraduate

Students


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Admission Booklet

1. Welcoming Message A NOTE FROM THE DEAN OF ADMISSIONS AND RECORDS DIVISION

2. Enrolment Guidelines

3. * Acceptance/Deferment/Rejection Form

4. * Financial Declaration Form

5. ** Health Examination Report ForInternational Student

6. ***Mahallah Registration Form

On enrolment day,* These forms are to be submied to the counter of Pre-Registraon and Submission

** This form is to be submied to the counter of Health Centre

*** This form is to be submied to the counter Mahallah

( L A S T U P D A T E : M a r c h 2 0 1 1 )

3

Admission Booklet ContentsFor International Undergraduate

Students


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Admission Booklet

I am so pleased to welcome you to the International Islamic University Malaysia. I would

also like to take this opportunity to congratulate you on geing a place at the University. I

can assure you that we have an exciting educational program awaiting you. I trust you will

find your time have rewarding and complimentary to your personal and professional goals.

At IIUM, we are blessed with beautiful surroundings. I am sure you will enjoy the beauty

of our campus and appreciate the opportunity to study at the great university. The

state-of-the-art program will equip you with the skills you need to gain control over your

own destiny.

Over the years, the University has built a strong reputation as one of the leading Universi-

ties in the Islamic world. We achieved this by exercising a tradition that fosters excellence

and unity in diversity.

We are delighted that you have selected the International Islamic University Malaysia. We

look forward to greeting you in person.

Dean

Admissions and Records Division

International Islamic University Malaysia

4

A Note From The Dean ofADMISSIONS AND RECORDS DIVISION

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INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA

Admission Booklet

Enrolment Guidelines

FOR NEW UNDERGRADUATE STUDENTS

1. CONGRATULATIONS for being selected to join the International Islamic

University Malaysia (IIUM).

1.1 All the information provided is to prepare you for enrolment at the Main

Campus, International Islamic University Malaysia, Gombak, Selangor

Darul Ehsan.

1.2 Please read carefully and follow the instructions given.

2. ACCEPTANCE / DEFERMENT / REJECTION

If you accept or reject our offer, you should: -

2.1 Fill in the Reply Form (IIUM-R1) enclosed together with the offer leer and a

copy of your payment slip transaction through mail/e-mail/fax.

2.2 Fill in all the relevant documents/forms (to be submied on the Enrolment

Day).

If you defer our offer: -

2.3 Submit the Reply Form (IIUM-R2) together with the offer leer to our

University by stating that you have to defer your study or rejected our offer

through mail/e-mail/fax. Note: No further application will be entertained

once you have rejected the offer.

3. ATTIRE DURING ENROLMENT AND ORIENTATION WEEK

MALE

3.1 Long sleeve shirt. All round boom shirts must be tucked in. 3.2 Dark coloured trousers.

3.3 Dark coloured shoes.

FEMALE

3.4 Wear Mini telekong or head gear.

3.5 National dress or dress which covers the aurah.

3.6 White Long skirt for special occasion (Orientation Week)

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Admission Booklet

4. You are required to bring along the original documents / itemsof the following on

the Enrolment Day: -

1. Identity Card and Birth Certificate (for Malaysian students only).

2. Birth Certificate or Passport (for International students only).

3. School leaving certificate (for Malaysian undergraduate students).

4. SPM / O Level certificate and STPM / A Level certificate or their equivalent.

5. Five recent photographs of yourself measuring 3 cm x 3.5 cm with your

name, matric number, programme offered to you wrien at the back of every

photograph. Bring them along during enrolment.

Note: -

a. You are required to submit your photographs to the following Unit / Divisions: -

1. Student Affairs & Development Div. 2 photos

2. Residence (Mahallah) 1 photo

(to be submied at the respective Mahallah Office)

3. Admissions and Records Division 2 photos

5 photos

b. Medical Check-up form and X-ray

i. All new students are required to do a medical check-up at the IIUM Health

Centre (except the IIUM Matriculation students). Please refer to Appendix

Bon the health requirements for International students.

ii. In addition, you are also required to bring an X-ray film on that day. In case

you cannot bring your X-ray, it can be done at the IIUM Health Centre.

iii. Please fill-in only Part 1 and 2 of the IIUM Medical Form (IIUM6-M). The

remaining parts will be filled by our Medical Officer.

iv. The above directive must be observed. For any assistance, you can contact

IIUM Health Centre upon your arrival in campus.

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Admission Booklet

1. GENERAL FEATURES

1.1 The aire should cover the whole body except the face and palms (for

sisters).

1.2 The aire to be worn should not be tight-fiing

1.3 Sarongs or skirts without slits may be worn if they are loose and long

enough to reach and cover the ankles.

1.4 Womens aire must not resemble that of mans.

2. PANTS

2.1 Pants should not be figure-hugging, cover the ankles, tailored and loose.

2.2 Pants may be worn with a long, loose upper dress covering the hips,

reaching as well as covering the knee and without slits.

3. BLOUSE

3.1 A long loose-fiing blouse, high-collared or high-necked with long sleeves

reaching the wrists may be worn.

4. HEAD-COVER

4.1 The headgear should cover the head, neck, chest and shoulder.

5. MATERIAL

5.1 Dress materials should not be transparent and revealing.

6. FOOTWEAR

6.1 Footwear should cover the feet, and the heels of the footwear should not be

excessively high i.e not more than 3 inches.

7

IIUM Dress Code

DRESS CODE FOR MUSLIM FEMALE STUDENTS

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Admission Booklet

1. The aire must cover the aurah of the male body.

2. i. Students should not wear slippers, round-neck T-Shirts, tight-fiing

trousers or pants during office hours, lectures, tutorials, formal indoor

University functions and other formal activities.

ii. Jeans are not encouraged but if they are to be worn by the students they

should not be tight fiing, multi-coloured, faded, fancy in design, torn or

with patches.

3. Shirts of unusual fashion should not be worn.

4. Neck and wrist chains should not be worn except for medicinal purposes or on

religious grounds.

5. The length of the hair should not extend beyond the collar and the hairstyle

should not be of unusual or extraordinary fashion.

6. National dress/aire may be worn provided they do not violate or infringe the

dress code.

8

IIUM Dress Code

DRESS CODE FOR MUSLIM MALE STUDENTS

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Admission Booklet

Orders of AireFOR STUDENTS

1. GENERAL ORDERS

1.1 All Students are required to display on their upper dress/shirt their

respective Students Identity cards at all material times whilst in Universitys

premises except when aending sports activities.

An offence under this Order is a compoundable offence and shall be dealt

with in accordance with the procedure in Rule 34 of the Students Discipline

Rules.

1.2 Students are not allowed to wear any aire or accessory, which symbolizeany particular external organization or group except on certain proper

occasions and with the permission from the University authorities. Students

aires must not display any provocative or detrimental designs, images,

words or phrases that may seem to be against the University Dress Code.

1.3 Jeans are not allowed to be worn except on non-formal occasions and during

physical activities such as sports or recreation, provided they are not

tight-fiing, multicoloured, faded, fancy in design, torn or with patches.

An offence under this Order is a compoundable offence and shall be dealt

with in accordance with the procedure in Rule 34 of the Students DisciplineRules.

1.4 National dresses/aires may be worn provided that they do not violate or

infringe the Universitys requirements and Islamic values and norms.

1.5 Vanity or ostentation should not be a motive in puing on of any dress or

aire.

1.6 The aire of men shall not resemble that of the womens and vice versa.

An offence under this Order is a compoundable offence and shall be dealtwith in accordance with the procedure in Rule 34 of the Students Discipline

Rules.

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Admission Booklet

2.0 ORDERS OF ATTIRE FOR FEMALE STUDENTS

2.1 General Features

For an example of the approved aire, refer to the illustrations in Appendix A.

2.1.1 As far as a female Muslim student is concerned, her aire must cover the

aurah(as provided under the Shariah). Save for the face and the palm the

aire should cover the whole body. Any form of clothing that covers the

face is prohibited.

An offence under this Order is a Compoundable Offence and shall be dealt with in

accordance with the procedure in Rule 34 of the Students Discipline Rules.

2.1.2 Aires shall not be tight fiing.

An offence under this Order is a compoundable offence and shall be dealt with in


2.1.3 The aire should be made from such material such that the colour of the

skin and shape of the body would not be visible. Dress materials should

not be transparent or reveal the contour of the body.



2.1.4 Sarongs and skirts without slits may be worn if they are loose and must be

long enough to reach and cover the ankles. Skirts which are tight or which

does not cover the ankles are not allowed.

An offence under this Order is a compoundable offence and shall be dealt with inaccordance with the procedure in Rule 34 of the Students Discipline Rules.

2.1.5 Excessive accessories, strong perfumes and facial make-ups are not allowed.

2.2 Pants

2.2.1 Pants should not be tight fiing or figure hugging; they should be loose and

cover the ankles.



2.2.2 Pants should be worn only with a long, loose upper dress, which covers the

hip. The upper dress should not have long slits or side cuts, which reveal

the hip or thigh area.



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Admission Booklet

2.3 Blouse

2.3.1 A loose-fiing blouse and upper dress may be worn provided they have

long sleeves reaching the wrists and covering the hips as well.

An offence under this Order is a Compoundable Offence and shall be dealt with in


2.4 Head-cover

2.4.1 For female Muslim students, the head-cover should properly cover the

head and should not reveal the hair, neck, chest and shoulders.

2.4.2 As for female Non-Muslim students, she may adopt Islamic dress, if she

so desires. Otherwise she should at least cover the head with a scarf or

shawl or similar headgear as a symbol of respect to the Islamic

University. For an example of the approve aire refer to the illustrations

in Appendix A.

An offence under this Order is a compoundable offence and shall be

dealt with in accordance with the procedure in Rule 34 of the Students

Discipline Rules.

Save as for convocation, the ceremonial aire for graduands, shall be

such as determined by the University from time to time.

2.5 Hair

2.5.1 As far as possible, students should avoid unnecessary dyeing or

colouring of hair. An offence under this Order is a Compoundable Offence and shall be dealt

with in accordance with the procedure in Rule 34 of the StudentsDiscipline Rules.

2.6 Footwear

2.6.1 Footwear should cover the feet, and the heels of the footwear should not be

excessively high. Slippers are forbidden.

An offence under this rule is a compoundable offence and shall be dealt with in

accordance with the Rule 34 herein.

3.0 ORDERS OF ATTIRE FOR MALE STUDENTS

For a beer perspective of the sample of approved aire, students shall refer to the

illustrations in Appendix A.

3.1 The aire of the male Muslim studentsmust cover the aurah (as provided

under the Shariah) of the male body.

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Admission Booklet



3.2 Slippers, non-strip sandals, round neck T-shirts, tight-fiing trousers or

pants should not be worn by students during lectures, tutorials, official

University functions and other formal activities as well as within the prox-

imity of the IIUM administrative and faculty buildings and centres. In all

the above occasions, jeans are absolutely not allowed.



3.3 Shirts and collared T-shirts are allowed to be worn when aending classes.

Except for bush jackets, properly-buoned Baju Melayu, batik shirts and

other proper national suits, the shirts and collared T-shirts should be

tucked in the trousers at all material times.

An offence under this Order is a compoundable offence and shall be dealt with inaccordance with the procedure in Rule 34 of the Students Discipline Rules.

3.4 T-shirts of all kinds are not allowed to be worn during formal University

functions and other formal activities unless expressly allowed by the

authorities for certain specific functions.



3.5 Neck and wrist chains should not be worn except for medical purposes or

on religious and/or traditional grounds.



3.6 The length of the hair should not extend beyond the collar and the hair-

style should not be of unusual or extraordinary. Unnecessary dyeing or

colouring of hair is prohibited.



3.7 The areas of the body between the navel and the knee shall be covered in

public at all times including in thehalls of residence(Mahallah) and allpublic premises, except under permissible circumstances such as

sporting events.



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Admission Booklet


13

1. You will only be officially enrolled as a student of IIUM upon payment of the

following fees:

a. Entrance Fees

b. Semester Fees (Tuition Fee, Recurrent Academic Fees, Hostel Fee)

c. Personal Bond

2. Self-financed students must provide the evidence in the Guarantee Leer form or

Bank Statements or Statutory Declaration that you have sufficient funds to cover

all expenses throughout your studies. You should allocate sufficient funds for

food, clothing, books, incidental expenses and necessary travel fare to and from

the University.

3. Payments* can be made in the following forms:

a. Bank Dra (Account No: 1407-0000005-71-9 (UIAM STUDENT))

b. Telegraphic Transfer (T & T) (SWIFT CODE: BMMBMYKL)

c. Credit Card (at hp://epayment.iiu.edu.my/eregister)

The payment should be made payable to:

Finance Director International Islamic University Malaysia

Or into the following bank account:

Bank Muamalat (M) Berhad

IIUM Branch, Gombak

53100 Kuala Lumpur, Malaysia

* Payments can be made in the following currencies: USD$, or Euro currencies

(equivalent to the Ringgit Malaysia RM amount)

4. Sponsored students will not be enrolled unless they submit the original leer of

offer from the sponsoring agency.

APPENDIX A

Tuition Fee and Other Related Administrative FeesFOR INTE RNATIONAL UNDERGR ADUATE

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5. ENTRANCE FEES

Orientation

Alumni

Registration

Student Identification card

College Deposit (Refundable)

University Caution money (Refundable)

Medical check-up

English and Arabic Placement Test

TOTAL ENTRANCE FEES

120.00

100.00

30.00

60.00

-

-

-

-

310.00

120.00

100.00

30.00

60.00

-

-

50.00*/75.00**

200.00

560.00*/585.00**

ENTRANCE FEES

(ONCE IN DURATION OF STUDY)

International

Ex-Matriculation***

RM

International

Direct

RM

* X-ray done outside the University. ** X-ray is carried out by the Universitys Clinic.

6. KULLIYYAH / PROGRAMME FEES

(PER SEMESTER-EXCLUDING SHORT SEMESTER)

Pre-SessionalLaws

EconomicsIslamic RevealedKnowledge & HumanSciences

Information TechnologyEngineering

ArchitectureScience

-BSMS

MedicineDentistry

PharmacyNursing

Allied Health Science

600.004,250.00

3,750.00

3,500.00

3,750.00

7,000.007,000.00

6,000.006,000.00

19,000.0019,000.0019,000.00

19,000.006,000.00

1,357.505,007.50

4,507.50

4,257.50

4,507.507,782.507,782.50

6,782.506,757.50

19,782.5019,782.50

19,782.5019,782.50

6,782.50

Examination

Library

Co-curricularActivities &

Transport

College activities

Medical Facilities

Welfare fund

Insurance

Computer Fee

Laboratory / Studio

RELATED FEES

157.50 157.50

157.50

157.50

157.50

182.50 182.50

182.50157.60

182.50182.50182.50

182.50182.50

600.00 600.00

600.00

600.00

600.00 600.00

600.00600.00600.00

600.00600.00

600.00600.00

600.00

25.00

25.00

37.50

25.00

15.00

2.50

2.50

25.00

25.00

182.50

25.00

25.00

37.50

25.00

15.00

2.50

2.50

25.00

-

157.50

UndergraduateProgramme

International

TuitionFee

(RM)

RecurrentAcademic

Fees*(RM)

HostelFees**

(RM)

Total(RM)

RECURRENTACADEMICFEES DETAILS*

(RM)

SCIENCEBASED(RM)

NONSCIENCE(RM)

** For Usrah/Transit room the rate is RM500.00 per semester

* NOTES: The University has the right to revise the fees without noficaon.

14

APPENDIX A


INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA (IIUM)

Admission Booklet

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7. PERSONAL BOND

All International students are required to pay a personal bond at the point of

enrolment, which is refundable upon completion of studies. The rate of the personal

bond varies by country as stipulated by the Malaysian Immigration Authority.

COUNTRY RATE (RM)

* Personal Bond of RM1, 500.00/USD395.00 is imposed on countries that are not listed above.

123456789

1011121314151617181920212223

24252627282930

AfricaAustraliaBangladeshBritish Commonwealth IndependenceBruneiCanadaChinaEuropeGermanHong KongIndiaIndonesiaIran/Iraq

JapanKoreaMacauMyanmarNepalPakistanPhilippinesPortugal Commonwealth IndependenceSaudi ArabiaSingapore

Sri LankaTaiwanThailandTunisiaUnited KingdomUSAVietnam

1,500.001,500.00

750.001,500.001,500.002,000.001,500.001,500.001,500.001,000.00

750.00500.00

1,500.001,000.001,000.001,000.00

750.00750.00750.00

1,500.001,500.001,500.00

200.00

750.00750.00300.00

1,500.001,500.002,000.001,500.00

395.00395.00198.00395.00395.00527.00395.00395.00395.00264.00198.00132.00395.00264.00264.00264.00198.00198.00198.00395.00395.00395.0053.00

198.00198.0079.00

395.00395.00527.00395.00

RATE (USD)NO.

8. Entrance Fee will not be refunded in the event the student withdraws from the

University.

9. The Tuition Fee and Related Fees paid will be refunded as follows in the event of

withdrawal or study leave:

a. 90% refund From first day up to first month.

b. 60% refund From first month up to the second month.

c. No refund Aer second month of semester.

10. In the event a student made an overpayment, he or she can request for either a

refund or the amount to be set off against future semester charges.

11. The University has the right to revise the fees without notification.

15

APPENDIX A



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Admission Booklet PageAdmissions & Records Division


Admission Booklet


1. ACCEPTANCE / REJECTION / DEFERMENT OF OFFER

i. Your reply usingIIUM-R1/ IIUM-R 2forms should reach us by the stipulated

date as stated in the offer leer, otherwise this offer of admission will

automatically be revoked.

ii. Please be reminded that International students are not allowed to enterMalaysia unless the Immigration Department of Malaysia has approved their

student pass. Therefore, please do not make any arrangements to come to the

university before you receive the leer of approval of your student pass from

our office. The university will not be responsible if you come to Malaysia

without the approval of your student pass and you will have to return to your

home country. The university will not provide any passage allowance for your

return or any extra allowance that you have to pay for the visa. All expenses

incurred must be borne by you.

You are also required to make the necessary traveling arrangements to Kuala

Lumpur, Malaysia. International students must ensure that your International

passport has a validity period of at least two (2) years.

iii. For further information, you can contact the universitys officers in the

following ways: -

Telephone number: 603-6196 4000 /4045 /4043

Extension: 3022 OR 3024

Fax number: 603-6196 4724

EMail address: [email protected]

16

Terms and Conditions of Offer and Enrolment(FOR INTERNATIONAL STUDENTS ONLY)

APPENDIX B

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Admission Booklet

2. HEALTH REQUIREMENTS (for international students only)

No cholera or smallpox vaccination certificate is required to be provided in order

to enter Malaysia. However, yellow fever vaccination is required from residents of

South America and Africa (except South Africa). The health regulations of the

country require those arriving from the above-specified regions without the validimmunization certificate or before the inoculation period, to be immediately

quarantined for six days.

Please be informed that you are required to undergo a Medical

Examination/Check-up in your respective country at the authorized government

hospital. The Medical Examination/ Check-up report must be presented to the

IIUM Health Centre during the medical check-up exercise conducted during the

orientation (Taaruf) week. However, all international students are required to

undergo a second screening at IIUM Health Centre upon enrolment prior or

during the orientation (Taaruf).

The university health requirement stipulates that the students who wish to

enroll into the university must be free of HIV/AIDS and drug addiction. As

such, you are required to undergo urine and blood tests at your home country.

The university has the right to ho can be contacted during emergency revoke the

admission of a student if he/she is found to be affected by the said disease or is

found positive for drug addiction.

3. ADVICE FOR MARRIED APPLICANTS

If you are married, you are advised to come alone to the university to undergo the

process of enrolment and course registration. Please be reminded that the

University will not be responsible for any maers pertaining to Immigration (such

as visa for your spouse or/and children) and will not provide any assistance if you

run short of funds.

4. ENGLISH PROFICIENCY TEST (EPT)

All new students are required to sit for the EPT. However, an exem if you can pres-

ent a score of 550 paper-based or 213 computer-based in the Test of English as a

Foreign Language (TOEFL) or overall Band 6.0 in the test administered by the

British Council (IELTS). The EPT test will be conducted during the first week of the

orientation programme. If you do not fulfill the English language proficiencyrequirements (for programmes that use English as a medium of instruction), you are

required to undergo the Pre-sessional Programme (PRSS) before proceeding to the

respective programme of studies and pay the tuition and academic administrative

fees while in the programme [please refer to Appendix A]. The maximum duration of

Pre-sessional Programme (PRSS) is two (2) years.

Please refer to the aached brochure on the EPT requirements.

17

APPENDIX B

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Admission Booklet

5. ARABIC PLACEMENT TEST (APT)

All new students are required to sit for the APT. The test will be conducted during

the first week of the orientation programme. Those who do not fulfill the Arabic

language proficiency requirements (for Arabic Language & Literature and Islamic

Revealed Knowledge & Heritage programmes) are required to do Pre-sessionalProgramme (PRSS) before proceeding to the respective programme of studies that

use Arabic as its medium of instruction. The maximum duration of the

Pre-sessional Programme (PRSS) depends on the respective Kulliyyah

requirement. The students are also required to pay the tuition and academic

administrative fees while in the programme [Please refer to Appendix A].

6. TILAWAH PLACEMENT TEST (TPT)

All new students are required to sit for the TPT to determine their level of

recitation and understanding of the Tajwid. There are two (2) levels that students

have to fulfill as their graduation requirements. The test will be conducted duringthe first week of the orientation programme. Those who are exempted from the

first level may proceed to the second level.

7. TAARUF (ORIENTATION) PROGRAMME (compulsory to all new students)

All students are required to aend Ta'aruf (Orientation Programme) conducted by

the university and participate in all the programmes organised by various bodies

of the university.

8. CODE OF CONDUCT

Students of the International Islamic University Malaysia are expected to observe

Islamic behavioral norms at all times on or off campus.

9. DRESS CODE

Please refer to Discipline of Student Rules 1984 [Amendment (2002)] handbook

for more details.

IMPORTANT NOTE:

NO STUDENT WILL BE ALLOWED TO ENROL WITHOUT THE ORIGINAL

ACADEMIC DOCUMENTS ON THE ENROLMENT DAY. IF THE UNIVERSITY

AUTHORITIES DISCOVER ANY FALSE DECLARATION AND THE USE OF

FORGED CERTIFICATES AND DOCUMENTS BY ANY STUDENT TO GAIN ENTRY

INTO THE UNIVERSITY BEFORE OR AFTER THE ENROLMENT, THIS OFFER OF

ADMISSION WILL BE REVOKED. THE UNIVERSITY MAY AT ITS ABSOLUTE

DISCRETION TAKE OR CAUSE ANY LEGAL ACTION TO BE TAKEN AGAINST

ANY STUDENT GUILTY OF COMMITTING FORGERY OR FRAUD.

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APPENDIX B

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Admission Booklet PageAdmissions & Records Division


Admission Booklet


19

1. I agree herewith and promise to pay all the fees as required by the University.

2. I agree that the University has the right to deduct from my scholarship or financial

aid given to me to sele the payments mentioned above.

3. I agree that the University has the right to demand the above payments from my

guarantor if I leave the University without seling them.

4. I agree that the University has the right to revise the fees without any notification.

5. I fully understand and accept all other conditions as stated in the OFFER LETTER,

ADMISSION BOOKLET AND APPENDICES.

IIUM2-D

NAME:

MATRIC NO.: PROGRAMME:

Signature of student: Date:

(Please fill up this form)

FINANCIAL DECLARATION FORM

APPENDIX C

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Admission Booklet 20

Health Examination Guidelines

FOR FOR ENTRY INTOMALAYSIAN HIGHER EDUCATIONAL INSTITUTIONS

1. PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING IN THE

FORM.

2. PLEASE FILL IN THE FORM IN ENGLISHLANGUAGE.

3. PLEASE WRITE IN CAPITAL LETTERS.

4. THIS FORM HAS 4 SECTIONS:

(a) SECTION 1 (PART A AND B) TO BE FILLED BY THE CANDIDATES; AND

(b) SECTION 2, 3 AND 4 TO BE FILLED BY THE EXAMINING DOCTOR

5. PLEASE COMPLETE ALL THE TESTS REQUIRED IN THIS FORM.

6. THE UNIVERSITY / COLLEGE ONLY ACCEPTS MEDICAL EXAMINATION

DONE WITHIN 60 DAYS BEFORE REGISTRATION OR WITHIN 30 DAYS

AFTER REGISTRATION.

7. PLEASE ATTACH ALL THE ORIGINALLABORATORY RESULTS.

8. PLEASE BRING ALONG CHEST X-RAY FILM A ND REPORT FOR

REGISTRATION.

9. PLEASE ENSURE THE X-RAY FILM IS LABELLEDWITH YOUR NAME ANDDATE TAKEN (IN ENGLISH).

10. CHEST X-RAY DONE WITHIN 6 MONTHSPRIOR TO REGISTRATION CAN

BE ACCEPTED.

11. THE UNIVERSITY / COLLEGE RESERVES THE RIGHT TO REPEAT FULL

MEDICAL CHECK-UP OR ANY SPECIFIC LABORATORY TESTS SHOULD

THERE BE ANY DOUBT IN THE MEDICAL REPORT SUBMITTED. ALL COSTS

INVOLVED SHALL BE BORNE BY THE CANDIDATES.

12. THE UNIVERSITY / COLLEGE RESERVES THE RIGHT TO REJECT ANY

APPLICATION:

(a) BASED ON THE RESULTS OF THE HEALTH EXAMINATION; OR

(b) SHOULD THERE BE ANY EVIDENCE THAT THE APPLICANT HAS

GIVEN FALSE INFORMATION IN THE HEALTH EXAMINATION

REPORT OR ANY SUPPORTING DOCUMENTS.

APPENDIX C

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INTERNATIONAL ISLAMIC UNIVERSIT Y MALAYSIA (IIUM)

Admission Booklet

HEALTH EXAMINATION REPORT

FOR INTERNATIONAL STUDENT

PLEASE USE CAPITAL LETTERS

SECTION 1(To be completed by candidate)

(PART A)

FULL NAME(As in passport)

INTERNATIONAL PASSPORT NO.

NATIONALITY CONTACT NUMBER

DATE OF BIRTH AGE SEX

MALE

FEMALED D M M Y Y

MARTIAL STATUS

SINGLE

MARRIED

ACADEMIC YEAR

Passport size

photo

STUDENT ID

PROGRAMME OF STUDY PROGRAMME CODE

NEXT OF KIN

NEXT OF KINS ADDRESS

NEXT OF KINS CONTACT NUMBER

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Admission Booklet

SECTION 1- Please tick( ) in the relevant box(PART B)

Declaration of self and family illness. Explain in full if you or your family has any of the following illnesses.

* Immediate family refers to father, mother, brothers / sisters

Congenital or inherited disorder

Allergy

Mental illness

Fits, stroke, other neurological

disease

Diabetes Mellitus

Hypertension

Heart or vascular disease

Asthma

Thyroid disease

Kidney disease

Cancer

Tuberculosis

Drug addiction

AIDS, HIV

History of surgery

Other illnesses

MEDICAL PROBLEMSSELF

IMMEDIATEFAMILY

Yes No Yes No

If Yes please state.

Current medication (Long term)

IMMUNIZATION HISTORY(where applicable)

DATE IMMUNIZED

Yellow Fear

BCG

Meningitis (Quadrivalent)

Hepatitis B

Others:

I hereby certify that the information given above is true. I understand that my application will be rejected if there

is any false information given.

......................................

Date

....................................................

Signature of candidate

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

1.

2.

3.

4.

5:

22

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Admission Booklet

2. GENERAL EXAMINATION

ITEM YES NO COMMENT

a. DEFORMITIES

b. PALLOR

c. CYANOSIS

d. JAUNDICE

e. OEDEMA

f. SKIN DISEASES

3. SYSTEMIC EXAMINATION

ITEM NORMAL COMMENT

a. EYES (including funduscopy)

b. EARS

c. NOSE

d. ORAL CAVITY / THROAT

e. NECK

f. HEART

g. LUNGS

h. ABDOMEN / HERNIA ORIFICES

i. NERVOUS SYSTEM

j. MENTAL CONDITION

k. MUSCULOSKELETAL SYSTEM

SECTION 2 - PHYSICAL EXAMINATION

(To be filled by examining doctor)

1. BASIC MEASUREMENT

HEIGHT : __________________ m BLOOD PRESSURE : ______________ mmHg

WEIGHT : __________________ kg PULSE RATE : ______________ / min

VISION TEST : Unaided : (R) _______ (L) ________

Aided : (R) _______ (L) ________

COLOUR VISION TEST :

NORMAL / ABNORMAL

23

ABNORMAL

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Admission Booklet

URINE TEST

ITEM DATE TAKEN RESULT

a. ALBUMIN

b. SUGAR

c. MICROSCOPIC

d. MORPHINE

e. CANNABIS

f. AMPHETAMINES TYPE

STIMULANT

BLOOD TEST

ITEM DATE TAKEN RESULT

a. HEPATITIS Bs ANTIGEN

b. HEPATITIS C

c. HIV

d. VDRL / TPHA

e. MALARIAL PARASITE

CHEST X-RAY INFORMATION

CHEST X-RAY NO.

DATE TAKEN

PLACE TAKEN

REPORT

24

SECTION 3 - INVESTIGATIONS

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Admission Booklet

I certify that I have on this date ___________________ examined

Remarks By University Official :

IN GOOD HEALTH

HAVING THE FOLLOWING MEDICAL COMPLICATION(S) (Please State)

UNDERGOING TREATMENT FOR:(Please State)

Please tick ( ) in the appropriate box :

SECTION 4 - CERTIFICATION BY THE EXAMINING DOCTOR

Mr. / Ms. _______________________________________________________ ,

Signature of Doctor / Date

Name of Doctor:

Qualification:

Hospital/Clinic:

Registration No.:

Official stamp:

Passport No.: ______________________ and found him/her :-

25

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Admission Booklet

INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIAINTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA (IIUM)

28

APPENDIX C


1. Full Name: ................

2. Matric. No.: ...

3. Programme: ...

Please tick ( ) one of the followings:

I accept the offer of admission

I do not accept the offer of admission (Please note that no further appeal or

application will be entertained once you have rejected the offer).

I also accept all terms and conditions as stated in the Offer Leer as well as in the

APPENDICES.

DECLARATION OF CANDIDATE

I accept that if, in reading and completing the application form and accepting the offer, I

knowingly or carelessly provided untrue or incomplete information,

a. any offer of admission, whether accepted or not, may be withdrawn by IIUM;

b. I may be required to withdraw from the University or from any course in which I

am enrolled;

c. I may be subjected to disciplinary actions.

I agree that IIUM may verify any of the information provided by contacting the relevant

institution or person. I agree to comply with all rules and regulations of IIUM, presentand future.

Signature of Student: Date: ..

Note: If we do not receive any response from you aer the deadline as stated in the offer leer,

we assume that you are no longer interested in the programme and your offer will be

automatically revoked.

ACCEPTANCE / REJECT ION FORM

Dean



P.O. Box 10, 50728 Kuala Lumpur, MalaysiaFax No: 603-61964724

IIUM-R1

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Admission Booklet

INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIAINTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA (IIUM)

1. Full Name: ................

2. Matric. No.: ...

3. Programme: ...

Please tick ( ) one of the followings:

I would like to defer the admission to next intake

I also accept all terms and conditions as stated in the Offer Leer as well as in the

APPENDICES.

DECLARATION OF CANDIDATE

I accept that if, in reading and completing the application form and accepting the offer, I

knowingly or carelessly provided untrue or incomplete information,

a. any offer of admission, whether accepted or not, may be withdrawn by IIUM;

b. I may be required to withdraw from the University or from any course in which I

am enrolled;

c. I may be subjected to disciplinary actions.

I agree that IIUM may verify any of the information provided by contacting the relevant

institution or person. I agree to comply with all rules and regulations of IIUM, presentand future.

Signature of Student: Date: ..

Note: If we do not receive any response from you aer the deadline as stated in the offer leer,

we assume that you are no longer interested in the programme and your offer will be

automatically revoked.

29


DEFERMENT FORM

Sept. 201

Feb. 201

June 201

IIUM-R2

APPENDIX C

Dean



P.O. Box 10, 50728 Kuala Lumpur, MalaysiaFax No: 603-61964724

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adm book 1112

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