Malaysian StudentApplication Form

Application Form

International Student
- All sections must be completed.
- For international applicants, please email a set of the following documents to yeseducationconsultant@gmail.com
  - Certified copies of all academic qualifications (e.g. award certificate and transcript) - certified translated copy in English (if applicable)
  - A passport-sized photograph, 3.5cm x 5cm with blue background
  - Sponsor letter (if any)
  - A copy of your passport (all pages, each page in A4 size paper)
  - A certified copy of evidence of your English language proficiency (IELTS & TOEFL only)
  - Complete Medical Report Form which is endorsed by a registered physician in home country (optional)
  - Non Objection Certificate (NOC for sub-Sahara countries only)
  - Proof of payment of application fee
- Copies of documents and photographs submitted will be filed for our record purposes and will not be returned, even if the applicant decides not to continue with his/her application after submission. All information and documents will be kept in confidence and in accordance with the Personal Data Protection Act 2010.
- Failure to comply with these procedures may result in a delay in processing this application.
Education Consultant Name
(for office use only)
Select Program
Program Level*
Intake*
Courses*
Personal Details
Title*

MrMrsMsMiss
Full Name*
(as per NRIC/ Passport)
Passport Number*
Passport Valid Until*

DayMonthYear
Date
Email Address*
example@example.com
Date of Birth*

DayMonthYear
Date
Gender*

MaleFemale
Marrital Status*

SingleMarried
Country of Birth*
Permanent Address (home country address)

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Correspondence Address (address in Malaysia)

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Do you have any medical condition(s) that require(s) special assistance?*

YesNo
Please name the location of the nearest Malaysian Embassy / High Commision / Consulate for your student entry visa application:
Name of Country*
City*
Neighbouring Country (if there is none in your country)*
City*
Details of Parents/Guardian
(please fill in the following information for emergency contact)
Name of Father*
(as per NRIC/Passport)
Email
example@example.com
Telephone No. (Mobile)*
Telephone No. (House)*
Telephone No. (Office)
Name of Mother*
(as per NRIC/Passport)
Email
example@example.com
Telephone No.(Mobile)*
Telephone No.(House)*
Telephone No.(Office)
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Guardian*
Relationship*
Telephone No. (Mobile)*
Telephone No. (House)*
Email
example@example.com
Financial Resources
Please enter details of sponsor. Refunds (if any) will be made to the student unless authorized otherwise by the said sponsor. If fees are sponsored by institution or company, please provide a letter of sponsorship.
Name of Sponsor
Email
Relationship
Telephone No.
Correspondence Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Academic Qualification
Year Completed*
eg: 2015
Name of School/Instituition*
eg: SMK Kuala Lumpur
City/Town
State
Country*
Accomodation
Accomodation *

YesNo
Declaration
1. I certify that the information given herein is true and correct, and I acknowledge that any false and/or incorrect information or documentary evidence may result in the cancellation of my enrollment in the program of study.
2. I understand that the offer letter issued to me will become void if I fail to submit all the relevant documents and pay the required course fees by the due date.
3. I agree to inform the Registrar in writing of any change in the information given herein, and I understand that YES Edu Consultant will not be held liable as a result of my failure to do so.
4. I understand and agree that YES Edu Consultant shall forfeit the security deposit paid by me if I remain inactive for one year without notifying the Registrar in writing.
5. I understand and agree that YES Edu Consultant shall cancel my student visa and notify the relevant government agencies/bodies if I remain inactive for one year without notifying the Registrar in writing. (This is applicable to international students only.)
6. I understand and agree that any fees, deposits and/or monies due to me that remain unclaimed for a period of one year or more from the date of my becoming inactive in my program of study, will be transferred to any nominated education or charitable fund without further reference to me.
7. I understand and agree to use the technology resources and facilities at YES International College for educational, academic research and study purposes only, and YES International College shall not be held liable for any violation of rules and regulations relating to those resources perpetuated by me.
8. I hereby agree and authorise YES Edu Consultant to release my personal information given herein to any authorised agencies and/or bodies of YES Edu Consultant or its business partners for the purpose of enrolment, educational evaluation, transfer of courses and any other administrative process; and to any relevant government bodies/agencies for enforcement of the law.
9. I authorise and grant YES Edu Consultant the right to use my personal information such as name, credentials, academic record, image, and spoken and written records of my activities at YES International College, in posters, leaflets, brochures, advertisements, websites, films, electronic recordings and the like for the marketing and promotion of YES Edu Consultant's corporate image and programs of study, and/or any purposes incidental to it.
10. I understand and agree that YES Edu Consultant and its authorised representatives shall have unlimited use of, and exclusive rights, titles and interests including copyrights over, the materials mentioned in clause 8 herein, during and after my graduation from YES International College.
11. I understand and agree that YES International College shall release my examination results and my academic record to my parents and/or sponsor(s) as and when it is deemed necessary.
12. I understand and agree that if I revoke my consent to any of the terms specified in clauses 8, 9 & 10 herein, I must do so in writing to the Registrar of YES Academy, and that all actions taken by YES Edu Consultant prior to the revocation in exercise of their rights in respect of me will not be affected.
13. I understand and agree to comply with all policies, rules and regulations of YES Edu Consultant, including the rules and regulations of the respective departments, during my program of study at YES International College.
Declaration by Parents/Guardian/Sponsor if the applicant is below 21 years of age
Should be Empty:

Application Form

Select Program

Personal Details

Details of Parents/Guardian

Financial Resources

Academic Qualification

Accomodation

Declaration

Declaration by Parents/Guardian/Sponsor if the applicant is below 21 years of age