APPLICATION FORM
  Intake : Month Year
 
PROGRAMMES
 

Please write the number(s) of the programme(s) that you apply for:
First Choice
Second Choice
Third Choice
 
Please write the results of the following subjects:
Subjects
UEC
SPM
English
Mathematics
Bahasa Melayu
   

PERSONAL PARTICULARS
Chinese Name:
English Name:
Gender :
Male Female
Date of Birth:
 ( ex : ddmmyyyy )
Age :
NRIC No. :
( ex : 850521016961 )
Religion :
Nationality :
Malaysian Others:
Correspondence Address :
Post Code :
Tel. No. :
( ex : 07xxxxxxx )
hp.No : ( ex : 012xxxxxxx )
E-mail :
Permanent Address :
Post Code :
Tel. No. :
 

ACADEMIC RECORD

 
School Name
Town
District
Year of Graduation
Primary Education
Lower Secondary Level
Upper Secondary Level
Others
 
How did you learn about Southern College?
Newspapers Brochures Kith and Kin
Schools Education Fairs Internet
Our Students Others:
 
PARENT’S/GUARDIAN’S PARTICULARS
Chinese Name:
English Name:
Relationship:
Occupation :
Date of Birth : ( ex : ddmmyyyy )
NRIC No. : ( ex : 850521016961 )
Nationality :
Malaysian Others:
Correspondence Address :
Post Code :
Tel. No. : ( ex : 07xxxxxxx )
hp.No : ( ex : 012xxxxxxx )
E-mail :
 

SOUTHERN COLLEGE
PTD 64888, 15KM, JALAN SKUDAI, P.O. BOX 76, 81300 SKUDAI, JOHOR, MALAYSIA.
TEL: 07-5586605 FAX: 07-5563306 E-mail: registry@sc.edu.my Web page: www.sc.edu.my