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    Email

    Name (as per Identity Card/Passport)

    IC No. / Passport No.

    Gender

    Address

    Phone number:
    Please provide your mobile number if you have one. For international applicants, please provide the phone number inclusive of the country code, e.g., +673 3456 7890 (673 is the code for Brunei Darussalam).

    Level of study:
    Please choose your intended level of study from the choices provided.

    Note: Programmes 1 to 4 are offered at Gombak Campus while the rest are conducted at Gambang Campus.

    First choice:

    Second choice:

    Third choice:

    Date of birth (Please write date in digit, month in word and year in digit, e.g.: 10 Jan 2000)

    Place and country of birth

    Country of residence

    Nationality

    Applicant City (International Only)

    Region/State/Province (International Only)

    Ethnic Origin (Malaysian only)
    MalayChineseIndianSikhSarawak BumiSabah BumiOther

    Religion IslamBuddhistHinduSikhismOther

    Mazhab Shafi'iHanbaliHanafiMalikiOther

    Disability

    If you have a disability, please state it.

    Father's name (CAPITAL LETTER)

    Mother's name (CAPITAL LETTER)

    Guardian's name (if not living with parents)

    Parent's or guardian's current occupation

    Parent's or guardian's monthly income in either Malaysian currency (MYR) or US currency (USD)

    Number of Dependent

    Phone number of parent / guardian / next of kin

    Correspondence address of parent / guardian

    Please upload relevant documents to the form. If documents are in languages other than Malay and English, notarized translations are needed.

    1. Your identity document:
    (i) For Malaysians: NRIC (MyKad).
    (ii) For International applicants: All pages of the passport.

    1.A. Your father's birth certificate (REQUIRED for Malaysians. For non-Malaysians, please upload your father's ID, e.g., passport's biodata page).

    1.B. Your mother's birth certificate (REQUIRED for Malaysians. For non-Malaysians, please upload your mother's ID, e.g., passport's biodata page).

    2. Certificate of study (high school certificate/diploma).

    3. Academic transcript (statement of results of the high school certificate/diploma).

    4. TOEFL/IELTS statement of result (if any).

    If you are non-Malaysian, please upload your parent's or guardian's bank statement covering the period of at least the last 3 months

    Please click the relevant processing fee (This fee is non-refundable):

    Please make payment of processing fee to IIUM Academy's account number: 1407 0000 010 710.
    Beneficiary/Account name is IIUM CONTINUING EDUCATION CENTRE. Bank name and address: Bank Muamalat Malaysia Berhad, Azman Hashim Complex, International Islamic University Malaysia, 53300 Kuala Lumpur. SWIFT CODE: BMMBMYKL

    Please upload proof of processing fee payment.

    Did you decide to apply after getting information about IIUM ACADEMY's programmes from one of our representatives/registered agents or an introducer?

    If YES, please provide the name of the representative/agent/introducer.

    How did you get to know about this programme?

    Declaration:

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