1. Personal Information
I am a:
Malaysian Student Non-Malaysian Student
   
First Name
   
Last Name / Surname
   
Date of Birth Day Month year
   
  Identity Card No
( Eg: 870110065298 )
   
  Gender
Male Female 
   
Mobile No. - -
Country code - Area code - Phone Number
   
   
  2. Permanent Address
     
City / Town
 
   
State
 
   
 
3. Academic Qualification
   
Result
   
   
Institution/University Grade
   
   
Institution/University Grade
   
   
   
  4. English Qualification
Band    
       
   
       
   
       
   
   
   
  5. Work Experience (Applicable to postgraduate applicant)
   
   
   
   
  6. Programme Preferred 1  
Mode Study  
 
Programme Level/Study
 
 
 
 
 
 
 
 
  7. Programme Preferred 2  
 
 
Programme Level/Study
 
Faculty / School
 
 
Campuses
 
Intake Month
 
 
 
 
  8. Programme Preferred 3  
 
 
Programme Level/Study
 
Faculty / School
 
 
 
Intake Month
 
 
  9. Declaration & Agreement by Applicant  
 
I decare that the information provided by me in connection with the application is true and correct. I undertake to inform SEGi University immediately of any changes in address, phone number and any other information provided by me in this application. I understand that SEGi University reserves the right to vary or reverse any decision regarding admission or enrolment made on the basis of incorrect or imcomplete information. I agree to be bound by the Terms and Conditions of the offer to student at SEGi University .  
     
  10. Declaration by Parent / Guardian / Sponsor / (Applicable of applicants who are 21 and below)
   
   
Relationship
   
Company
   
Occupation
   
Telephone No.
   
E-mail Address
   
   
City / Town
   
State
   
   
Country
   
   
11. Verification
I allow SEGi University Group to contact me (your details will not be given to any third party)
I agree to SEGi University Group's Terms & Conditions and Privacy Policy