September 26, Tuesday 2017
Login
Application for Admission

* - are compulsory fields.
1. PROGRAMME SELECTION
Programme Name*
Intensive English Programme(IEP) English Immersion Programme (EIP) English for Professional Communication (EPC)
Professional English for Managers and Executives (PEME) IELTS Preparation Class IELTS Preparation Workshop

Other Programme 

Intake*
January February March April May June
July August September October November December

2. PERSONAL PARTICULARS
Full Name
IC Number*
Passport Number* Passport Expiry Date     Year 
Date of Birth*     Year  Country of Birth*
Gender* Marital Status*
Nationality* Country of Permanent Residence*
 
Mailing Address*
(Home)
Postcode* City/Town*
State* Country*
 
Phone Number(Home) Phone Number(Mobile)
Email*
 
Mailing Address
(In Malaysia, if different from above)
Postcode City/Town
State Country
 
In case of emergency, please contact:
Full Name*
Relationship* Phone Number*

3. ACADEMIC QUALIFICATIONS
Qualification Name of School/Institution
Qualification Name of School/Institution
Qualification Name of School/Institution
Qualification Name of School/Institution

4. WORK EXPERIENCE(if applicable)
Job Title Organization Name Start Date End date

5. FUNDING OR FINANCIAL ASSISTANCE
Sponsored by Employer Scholarship Others (please specify)
Sponsored by Government Self Financing

6. Do you require a student visa? Yes No
7. Do you need assistance in finding accommodation? Yes No
8. Do you need medical insurance? Yes No
 
9. How did you find out about CEL UNIRAZAK?
Newspaper Internet/Homepage Education Fair
Friends/Colleagues School/Counsellor Agents
Others
 
10. Do you intend to continue your education in Malaysia after CEL?
If YES, which college/university and what programme?
Yes No

11. DECLARATION BY APPLICANT*
I attest that I have personally filled in this form and the information contained herein is complete and accurate to the best of my knowledge. I understand that withholding information or giving false information will make me ineligible for admission. I also understand that I may be required to appear for an interview or to undergo such test that may be requested by the Centre as a condition for admission to the programme of study for which I have applied.