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GERMAN-MALAYSIAN INSTITUTE Programme Application Form

Jalan Ilmiah, Taman Universiti, 43000 Kajang,Selangor


Tel: (603) 8921 9191/ 9344 | Fax: (603) 8921 9001/9003 | http://www.gmi.edu.my
A. PERSONAL DETAILS | BUTIRAN PERIBADI
Name
Nama
MyKad No. Date of Birth
No.MyKad Tarikh Lahir
□ Muslim (Islam) □ Buddhism (Buddha)
Religion Place of Birth
□ Christianity (Kristian) □ Others/Lain-lain:
Agama Tempat Lahir
□ Hinduism (Hindu)
Marital Status □ Single (Bujang) Gender □ Male (Lelaki)
Status Perkahwinan □ Married (Berkahwin) Jantina □ Female (Perempuan)
□ Malay (Melayu) □ Bumiputera Sabah □ Others (Lain-lain)
Ethnic
□ Chinese (Cina) □ Bumiputera Sarawak
Etnik
□ Indian (India)

Postal Address
Alamat Surat-menyurat
Postcode District State
Poskod Daerah Negeri
Home Phone No. Handphone No.
No.Tel.Rumah No.Tel.Bimbit
E-mail Address
Alamat Emel
B. PROGRAMME PREFERENCE | PILIHAN PROGRAM
Diploma Programmes
Industrial Electronics Production Technology
Diploma in Engineering Technology Diploma in Engineering Technology
MEC (Mechatronics) TDT (Tool & Die Technology)
Diploma in Engineering Technology Diploma in Engineering Technology
EIT MOT
(Electronics & Information Technology) (Mould Technology)
Diploma in Engineering Technology Diploma in Engineering Technology
PIC PDM
(Process Instrumentation & Control) (Product Design & Manufacturing)
Diploma in Engineering Technology
NWS Diploma in Network Security CPT
(CNC Precision Technology)
Diploma in Engineering Technology Diploma in Engineering Technology
SPD SMT
(Sustainable Energy & Power Distribution) (Sheet Metal Fabrication & Product Development)
Diploma in Engineering Technology Diploma in Engineering Technology
IPM MFS
(Industrial Plant Maintenance) (Manufacturing System)
Diploma in Engineering Technology Diploma in Engineering Technology
FBA MTM
(Facilities & Building Automation) (Machine Tools Maintenance)
Diploma in Engineering Technology Diploma in Engineering Technology
AHS IDE
(Autotronics & Hybrid System) (Industrial Design)
Diploma in Engineering Technology Diploma in Engineering Technology
ICS (Industrial Communication System) JDM (Jigs & Fixture Design And Manufacturing)
Diploma in Engineering Technology
CRM Diploma in Creative Multimedia IQM (Industrial Quality Management)
Diploma in Software Engineering
SET (Software Testing)
Pre-University Programme
GAPP German A-Level Preparatory Programme
*Please attach photocopy of MyKad, SPM/SPMV/STPM results slip/ Technical Certificate with transcript for each semester.
(Sila kepilkan salinan MyKad, slip keputusan SPM/SPMV/STPM/ SijilTeknikal berserta transkrip setiap semester)

Applicant Signature: Date:


For Office Use / Untuk Kegunaan Pejabat
□ Completed □ SPM/SPMV □ IKM □ Pre-Diploma □ ELIGIBLE
□ Final Semester Credit: □ ILP □ Matriculation □ NOT ELIGIBLE:
□ POLI □ Others
□ STPM □ SKM3

Source /Introducer:
Disclaimer: GMI has the right not to process this application if the information furnished is incomplete or submitted without the required documents attached.

Training For Advanced Technology GMI-MPR-P01-F01-Rev 03

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