Intake: Year Month

Local Student International Student

Course Selection 课程选择:

Personal Particulars 个人资料:

Chinese Name: English Name: *
IC / Passport: * Race:
Gender: Male Female Nationality:
Religion: Age:
Marital Status: Single Married Tel No. (H/P): *
Tel No. (H): Email: *
Correspondence Address:    
Permanent Address: *    

Parent / Guardian Particulars 家长/监护人资料:

Chinese Name:
English Name: *
IC / Passport: Family Income:
Relationship: Race:
Religion: Nationality:
Occupation: Tel No. (H/P):
Permanent Address:    

Emergency Contact (2 persons) 紧急联络人 (2位):

1. Chinese Name:
English Name:
  Relationship: Tel No.:
2. Chinese Name:
English Name:
  Relationship: Tel No.:

Academic Record 学历:

  School Name Town/District Year of Graduation
Primary Education

Status of Health 健康状况

Declaration of illness. Explain in details if you having ang following symptoms

Type of Disease Yes No If "Yes", Please state
Congenital or Inherited Disorder 先天性或遗传性失调
Allergy 敏感
Mental Illness 精神疾病
Fits, stroke, other neurological disease 癫痫、中风、神经系统疾病
Heart of Vascular Disease 心脏或血管疾病
Asthma 哮喘
Tuberculosis 肺结核
Drug Addiction 药物成瘾
AIDS or HIV 艾滋病


Self Declaration 宣誓书

I hereby affirm that all information in this application is complete and accurate. It is my understanding that I will not be consideredfor admission to Southern University College until I have submitted all of the required documents & Declare that I enroll and register only with Southern University College, I pledge that during the period of my study, I will follow the rules and regulation as required by the University College. 兹认签上述各项填报属实并附上以下证件。若有未尽善处,此申请将不被处理并仅向南方大学院注册入学。求学期间,愿遵守学院各规章,并服从师长之指导,专心向学