CENTEXS ONLINE APPLICATION FORM

Read this application form carefully, complete all selections and ensure that supporting (certified) documents are attached. For any enquiries please email study_abroad@centex-sarawak.my

Gender*
Male Female

First Name*

Last Name*

Date of Birth*

Email Address

Please provide a valid email address.

Home Address*

Country*

State*

City

Postcode

Correspondent Address*

Country*

State*

City*

Postcode*

Telephone*

Mobile*

Country of citizenship*

Submission location* What country were you in when you submitted this application?

Marital Status*

Ethnicity

Religion*

Passport/Identity Card Number

Passport expiry date*

Country of birth*

Do you hold a valid Malaysian visa?*
Yes No

Have you ever had a visa application rejected?*
Yes No

Family Name*

Given Name*

Email Address

Please provide a valid email address.

Home Address*

Country*

State*

City*

Postcode*

Telephone*

Mobile*

Language(s) spoken*

Relationship to you*

Have you completed your Covid-19 vaccination?*

Yes No

Have you been granted a scholarship/loan of any kind?*

Yes No

No.	Campus	Intake	Programme
1
2
3

Is English your first language?*

Yes No

Have you taken an English proficiency test?*

Yes No

A certified copy or original transcript of all official results must accompany this application. Please include the grading system to enable interpretation of academic results. List any studies you have endeavored, whether complete or incomplete.

Secondary school studies

MONTH/YEAR COMMENCED	MONTH/YEAR COMPLETION	TITLE OF COURSE
e.g. January 2018	expected or actual	e.g. A Levels

Tertiary or post-secondary studies

MONTH/YEAR COMMENCED	MONTH/YEAR COMPLETION	TITLE OF COURSE
e.g. January 2018	expected or actual	e.g. A Levels

Please make sure the following certified copies are attached (if applicable):

Passport size photo (Blue Background)

One set (all pages) Passport

I certify that the information provided in this application is accurate and complete. I further declare that any tertiary academic records provided are a complete record of all results acquired from all tertiary institutions I have attended.
I understand that failing to provide my academic record may result in the CENTEXS cancelling an offer or terminating my studies at any time.
I authorise CENTEXS to verify my academic and professional credentials. I acknowledge that CENTEXS may notify other tertiary institutions and regulatory bodies if any of the information given to support my application is proven to be incorrect.
I agree that I will be expected to provide originals of any papers used to support my application at the time of enrolment.
I understand that CENTEXS reserves the right to change any course, subject, admission requirement, intake date, or cost at any time and without notice.
I am informed that the personal information I have submitted may be disclosed to government entities as by law. I also accept that it may be disclosed to other parties in order to complete my application.
I understand that by signing this form, I agree to be bound by the CENTEXS Privacy Notice and grant permission to process my personal data in order to complete this contract.
I certify that CENTEXS may use and share my personal data for the purposes of admission.
I acknowledge that CENTEXS reserves the right to reject this application at its absolute discretion.

I have read and understand the Application Declaration

CENTEXS ONLINE APPLICATION FORM

A. PERSONAL INFORMATION

B. EMERGENCY CONTACT DETAILS

C. HEALTH DECLARATION

D. COVID-19 VACCINATION STATUS

E. SCHOLARSHIP

F. PREFERRED PROGRAMME

G. ENGLISH LANGUAGE PROFICIENCY

H. EDUCATION INFORMATION

I. Attachments

J. APPLICANT DECLARATION