APPLICATION FORM

    Documents submission (Files may not exceed 3 MB each and all the documents uploaded must be legible)

    The scanned document must be in JPEG, JPG, GIF, BMP, TIFF, PNG or PDF format only.
    The scanned documents must be attached as ONE attachment.

    SELECT RECIPIENT

    Please select the introducer. If you are enrolling on your own, left it as default ("Self Enrollment").*

    Please fill in RCC Student/Staff Name IF they introduce you.
    RCC Student/Staff Name:
    Please fill in Non-RCC Student/Staff Name & School/Workplace IF they introduce you.
    Non-RCC Student/Staff Name: School/Workplace:

    PROGRAMME DETAILS

    Please select your choice of programme.

    PROGRAMME*

    PERSONAL DETAILS

    Please complete all sections in this form in BLOCK letters.

    Name (as per NRIC/passport)*
    Nationality* MalaysianOthers
    NRIC No. (Malaysian Only)
    Identification Card (IC) (Front + Back)
    (please specify)
    Passport No. (Non Malaysian)
    Passport sized photo

    Scanned Passport (including cover)
    Gender* Date of Birth*
    Race * Religion*
    Home Tel. No. Email*
    Mobile Phone No.* Marital Status*
    City* Postcode *

    Full Address *
    Country *

    ACADEMIC BACKGROUND

    SPM/O LevelUECSTPM/A LevelDIPLOMADEGREEMASTEROTHERS

    Scanned Certified SPM/ UEC/ STPM/ A Level

    Name of School / Institution

    Academic Results (5 best subjects which must include Bahasa Malaysia, English, History and Mathematics)

    Subject Grade
    1. 1.
    2. 2.
    3. 3.
    4. 4.
    5. 5.
    6. 6.
    7. 7.
    8. 8.
    9. 9.
    10. 10.

    ENGLISH LANGUAGE PROFICIENCY

    Test Name
    Mark / Grade
    English test result
    Year Taken

    CREDIT TRANSFER

    Do you wish to apply for credit transfer from previous study?YesNo

    *If Yes, please include relevant course/module syllabus or curriculum from University/College that you attended.
    Information required by the Ministry of Higher Education Malaysia.
    Academic transcript with grading system

    SPORTS & CLUBS BACKGROUND

    List down sports and clubs involvement during previous study:

    Date Sports / Club Level (school / state / national) Best Achievement

    MEDICAL SPECIAL NEEDS BACKGROUND

    The information below is used to assist RC College in monitoring, supporting and improving service to students with medical disability requirements. Disclosing this information will not affect your admission to the college.

    Do you have a disability, impairment or long term medical condition which may affect your studied? YesNo

    *If Yes, please indicate the type(s) of medical condition.

    HearingVisionLearningMedical Mobility

    Other (Please Specify)
    Original medical report

    PARENTS INFORMATION

    Father's Name Mother's Name
    Home Tel. No. Home Tel. No.
    Mobile Phone No. Mobile Phone No.
    Profession Profession

    EMERGENCY CONTACT INFORMATION

    Guardian Name* Relationship*
    Home Tel. No.* Mobile Phone no.*
    Full Address*

    STUDENT VISA / PASS (FOR NON MALAYSIAN PASSPORT HOLDER)

    Student with non Malaysian passport is required to have a student visa / pass to study in Malaysia. RC College will assist in processing the student visa / pass. We require the following information to process your visa / pass.

    Nationality     Place / Country of Birth
    Passport No.    Place / Country where passport was issued
    Expiry Date         

    (if your country does not issue passports, please state the name of the travel documents you intend to use)

    Type of Immigration Pass / Visa N/ASocialStudentDependentDiplomatic

    Visa No. Expiry Date

    ACCOMMODATION

    Please indicate whether accommodation arrangement assistance is required or not.

    RequiredNot Required

    * If required, please complete the accommodation form together with payment of deposit.

    APPLICANT DECLARATION

    Declaration by Student

    I hereby accept and submit myself to the status, rules and regulations and ordinances (including By-Laws, codes and policies) of RC College and also the faculty or faculties in which I am registered and to any stipulated conditions prescribed by the management where applicable while I am a student at RC College and I promise to observe the same.
    1. I affirm that the information contained in the application form is correct and I have read all the information (course outline, fees structure, application procedure, loan procedure) regarding the course that I enrolled.
    2. I acknowledge that I have the responsibility to behave honestly, ethically and professionally in all of my dealings with RC College.
    3. I agree to act in accordance with the regulations, status and disciplinary procedures of RC College.
    4. I acknowledge that I am prevented from enrolling to any other institution once I submit my application form and also sign the student declaration that have been provided by RC College.
    5. I further confirm and consent to the use by RC College without charge, my personal information in any publicity and / or promotional exercise within RC College including without limitation photographs . images or recordings, the publishing of examination results, the award of prize or scholarship and any achievement, academic or otherwise.

    Student Name* NRIC / Passport No.*
    Date *    

    Declaration by parents/ guardian/ sponsor

    I acknowledge that my child personal information (including photographs and any other information) are correct and I hereby apply for his/her admission to RC College as a full time student and I undertake all the cost of this programme until completion

    Name * NRIC / Passport No. *
    Relationship * Mobile No.
    Date *