INTODUCER NAME : SULTAN ABDUL HALIM MU ADZAM SHAH INTERNATIONAL ISLAMIC UNIVERSITY (UniSHAMS) POSTGRADUATE AND RESEARCH MANAGEMENT CENTRE

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INTODUCER NAME : ………

STUDENT ID : ………...

I.C NUMBER : ………...

SULTAN ABDUL HALIM MU’ADZAM SHAH INTERNATIONAL ISLAMIC UNIVERSITY

(UniSHAMS)

POSTGRADUATE AND RESEARCH MANAGEMENT CENTRE BORANG PERMOHONAN

APPLICATION FORM

1. Gunakan PEN BERDAKWAT HITAM dan tulis dengan jelas dalam HURUF BESAR (borang yang tidak lengkap dan tidak boleh dibaca tidak akan diproses)

Use a BLACKPOINT PEN and write clearly in CAPITAL LETTERS (incomplete and illegible forms will not be processed)/

ذعث يس مًركي شيغ ةهط يأ .خضاو طخت ةركاو دىسلأا ىهقنا وذخرسا

2. Sila tandakan (√) di mana berkenaan

Please tick (√) where applicable /

اثساُي ِاشذ اي وايأ

(√)

حيلاع عض

A. BIDANG PENGAJIAN / FIELD OF STUDY /

حساسذنا لاجي

Program Yang Dipohon / Proposed Programme /

حشرقًنا جياَشثنا

Diploma Pascasiswazah Kehakiman & Guaman Syarie / Postgraduate Diploma in Judiciary & Syarie Advocacy - MQA/FA3670

Sarjana Bahasa Arab / Master of Arabic Language - A9861 Sarjana Syariah / Master of Sharia - A9805

Sarjana Usuluddin / Master of Usuluddin - A9806

Sarjana Pengajian Al-Quran / Master of Al-Quran Studies - MQA/FA0018 Sarjana Pengajaran Al-Quran / Master of Teaching Al-Quran - MQA/FA0017 Sarjana Kaunseling / Master in Counseling - MQA/FA0105

Sarjana Pentadbiran Perniagaan / Master of Business Administration - MQA/FA0019 Sarjana Kewangan & Perbankan Islam / Master of Islamic Banking & Finance - A9863 Sarjana Pengurusan / Master in Management – MQA/PA10011

Doktor Falsafah Kewangan & Perbankan Islam / PhD in Islamic Banking & Finance - A9864 Doktor Falsafah Pengurusan / PhD in Management - MQA/PA10012

Doktor Falsafah Kaunseling / PhD in Counseling – MQA/PA12131 Doktor Falsafah Usuluddin / PhD in Usuluddin - A9804

Doktor Falsafah Syariah / PhD in Sharia - A9803

Doktor Falsafah Bahasa Arab / PhD in Arabic Language - A9862

PPS01

Gambar / Photo /

ةرىص

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Mod Pengajian / Mode of Study /

حساسذنا عىَ

Sepenuh Masa / Full Time /

لهاك ماود

Separuh Masa / Part Time /

ًئسج ماود

B. BUTIR- BUTIR PERIBADI / PERSONAL DETAILS

/ حيظخشنا خاَايثنا

i. Nama Penuh / Full Name /

لهاكلا نسلاا

ii. No. Kad Pengenalan / Identity Card No. /

تقاطبلا نقر

iii. No. Pasport / Passport No. /

زاىجلا نقر

iv. Tarikh Lahir / Date of Birth /

دلاٍولا خٌرات

v. Taraf Perkahwinan / Marital Status /

تٍعاوتجلاا تلاحلا

Bujang / Single /

بسع

Berkahwin / Married /

جوسته

vi. Umur / Age /

روعلا

vii. Jantina / Gender /

سٌجلا

Lelaki / Male /

ركر

Perempuan / Female/

ىثًأ

viii. Kewarganegaraan / Nationality /

تٍسٌجلا

ix. Alamat Tetap / Permanent Address /

نئاذلا ىاىٌعلا

x. Poskod / Poscode /

يذٌربلا سهرلا

xi. Bandar / City /

تٌٌذولا

xii. Negeri/Negara / State/Country /

تلوذلا / تٌلاىلا

xiii. No. Telefon / No. Telephone /

فتاهلا

xiv. E-mel / Email /

لٍوٌإ

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C. PENGALAMAN KERJA / WORKING EXPERIENCE

/ حيهًعنا جشثخنا

Tarikh/ Date /_{خيسارنا}

Jawatan / Position /

تفٍظ ىلا

Nama & Alamat Majikan / Name & Address Employer /

مذخولا ىاىٌع

Dari/ From/

يه

Hingga/ To /

ىلإ

D. KELAYAKAN AKADEMIK/ ACADEMIC QUALIFICATIONS

/ حيًهعنا خلاهؤًنا

Universiti/University/

تعهاجلا

Nama Ijazah Diperoleh/

Name of Degree Awarded/

تٍولعلا تجرذلا

Tahun Masuk/

Year of Entry/

قاحتللاا تٌس

Tahun Berijazah/

Year of Graduation/

جرختلا تٌس

Kelas Kepujian/Honours

Classification/

CGPA or equivalent/

رٌذقتلا

E. KEMAHIRAN BAHASA INGGERIS / ENGLISH LANGUAGE PROFICIENCY/

حيزيهجَلإا حغهنا جداجإ

Requirements Tick ( / ) Year Taken

1. IELTS 4.0/ CERF B1 or 2. TOEFL PBT (410-413) or 3. TOEFL IBT (30-31) or

4. CAE (140) (Cambridge English : Advance)/ CEFR B1 or 5. CPE (180) (Cambridge English : Proficiency/CEFR C1 or 6. PTE (Pearson Test of English (36) or

7. MUET (Malaysian University English Test) (Band 2)

Nota : Bagi Skor Pelajar Antarabangsa : Sarjana Pengurusan & PhD Pengurusan skor IELTS 6.0 atau TOEFL 550 Sarjana Pentadbiran Perniagaan skor IELTS 5.5 atau TOEFL 525

Note : For International Students Score : Master in Management & PhD in Management IELTS 6.0 or TOEFL 550 scores Master in Business Administration IELTS 5.5 or TOEFL 525 scores

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F. SOKONGAN KEWANGAN / FINANCIAL SUPPORT /

حساسذنا فيناكذ

Tajaan / Scholarship /

حيساسد حذُي

Fully sponsored by my employer/home government (attach relevant documents)

ذهثنا حيىكد /وذخًنا :حياعس دذذ

Lain-lain (sila nyatakan) / Other (please specify)

) حهجنا خيضىذ ءاجشنا ( يشخأ حهج

*Sila lampirkan salinan sijil yang telah disahkan, penyata terkini akaun bank (3 bulan) / Surat jaminan kewangan/

* Please attach certified photocopy, the latest statement of bank account (3 month) / Letter of financial guarantee/

*

) شهشأ 3 ( باسذنا فشك ٍي جسىط قافسإ ءاجشنا

Nama dan alamat atau organisasi yang menaja anda / Name and address of person or organization sponsoring you

ي كهفكذ يرنا حهجنا وأ ضخشنا ىسا ايدا

G. PENGALAMAN PENYELIDIKAN / RESEARCH EXPERIENCE /

حيثذثنا خاشثخنا

Tajuk/Title

/ ىاىٌعلا

Penganjur/Organizer/

/

توظٌولا تهجلا

Tempoh/Duration/

تقىلا

H. RUJUKAN / REFEREES /

ىهينإ عىجشنا ٍكًي صاخشأ

Namakan dua (2) pengadil untuk permohonan anda. Pastikan pengadil anda menggunakan borang laporan pengadil yang dilampirkan.

Name two (2) referees for your application. Ensure your referees use the referees report form attached.

ىعذن ىهينإ عىجشنا ٍكًي ٍيزنا صاخشلأا ٍي ٍيُثا ِّ ىس

ِاَدأ اًهظخذ يرنا جشقفهن ىهياذخرسا ٍي ذكأذ .كثهط

Person 1 /

لولأا ضخشنا

Person 2 /

يَاثنا ضخشنا

Name/

ىسلاا

Position/

حفيظىنا

Address/

ٌاىُعنا

Mobile No.

Fax No.

Email

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I. PENGAKUAN / DECLARATION /

ساشقإ

Saya dengan ini mengaku bahawa semua maklumat dan dokumen yang diberikan adalah benar dan lengkap. Saya mengakui bahawa Universiti Islam Antarabangsa Sultan Abdul Halim Mu’adzam Shah (UniSHAMS) boleh menolak permohonan saya / menarik balik tawaran kemasukan jika maklumat dan dokumen yang disediakan didapati palsu atau tidak lengkap.

I hereby declare that all information and documents provided are true and complete. I acknowledge that Sultan Abdul Halim Mu’adzam Shah International Islamic University (UniSHAMS) may reject my application/withdraw the offer of admission if the information and documents provided are found to be false or incomplete.

ىهعًنا عيًج ٌأت شقأ ،حذيذط ِلاعأ خاي

و ىهعأ إ يثهط يغهرس حعياجنا ٌأ .حظقاَ وأ حذيذط شيغ خايىهعًنا دَاك ار

Nama/Name/

ىسلاا

: __________________________________________________________________________________

Tandatangan Pelajar/ Students Signature/

عيقىرنا

:

__________________ Tarikh/Date/

خي سارنا

: _________________