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Title --- Please Select --- ASSOCIATE PROF. DR. ASSOCIATE PROFESSOR CIK DATO' DATUK DR. ENCIK IR. MADAM MR. MRS. MS. PROFESSOR PUAN TAN SRI Please select title

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Nationality AFGHAN ALBANIAN ALGERIAN AMERICAN AMERICAN SAMOAN ANGOLAN ANGUILLAN ANTIGUAN ANTILLEAN ARGENTINIAN ARMENIAN ARUBAN AUSTRALIAN AUSTRIAN AZERI BAHAMIAN BAHRAINI BANGLADESHI BARBADIAN BASOTHO BELARUSIAN BELGIAN BELIZEAN BENINESE BERMUDIAN BHUTANESE BOLIVIAN BOSNIAN BOTSWANAN BRAZILIAN BRITISH VIRGIN ISLANDER BRITON BRUNEIAN BULGARIAN BURKINABE BURMESE BURUNDIAN CAMBODIAN CAMEROONIAN CANADIAN CAPE VERDEAN CAYMANIAN CENTRAL AFRICAN CHADIAN CHILEAN CHINESE CHRISTMAS ISLANDER COCOS ISLANDER COLOMBIAN COMORIAN CONGOLESE CONGOLESE COOK ISLANDER COSTA RICAN CROAT CUBAN CYPRIOT CZECH DANE DJIBOUTIAN DOMINICAN DOMINICAN DUTCH EAST TIMORESE ECUADORIAN EGYPTIAN EMIRIAN EQUATORIAL GUINEAN ERITREAN ESTONIAN ETHIOPIAN FAEROESE FALKLAND ISLANDER FILIPINO FINN FRENCH GABONESE GAMBIAN GEORGIAN GERMAN GHANAIAN GIBRALTARIAN GREEK GREENLANDER GRENADIAN GUADELOUPEAN GUAMANIAN GUATEMALAN GUIANESE GUINEA-BISSAU GUINEAN GUYANESE HAITIAN HONDURAN HONG KONG CHINESE HUNGARIAN ICELANDER INDIAN INDONESIAN IRANIAN IRAQI IRISH ISRAELI ITALIAN IVORIAN JAMAICAN JAPANESE JORDANIAN KAZAKH KENYAN KIRIBATIAN KITTSIAN KUWAITI KYRGYZ LAO LATVIAN LEBANESE LIBERIAN LIBYAN LIECHTENSTEINER LITHUANIAN LUXEMBOURGER MACANESE MACEDONIAN MAHORAIS MALAGASY MALAWIAN MALAYSIAN MALDIVIAN MALIAN MALTESE MARSHALLESE MARTINICAN MAURITANIAN MAURITIAN MEXICAN MICRONESIAN MOLDOVAN MONEGASQUE MONGOLIAN MONTSERRATIAN MOROCCAN MOZAMBICAN NAMIBIAN NAURUAN NEPALESE NEW CALEDONIAN NEW ZEALANDER NICARAGUAN NIGERIAN NIGERIEN NIUEAN NORFOLK ISLANDER NORTH KOREAN NORTHERN MARIANA ISLANDER NORWEGIAN OF FIJI OMANI PAKISTANI PALAUAN PANAMANIAN PAPUA NEW GUINEAN PARAGUAYAN PERMANENT RESIDENT OF MALAYSIA PERUVIAN PITCAIRNER POLE POLYNESIAN PORTUGUESE PUERTO RICAN QATARI REUNIONESE ROMANIAN RUSSIAN RWANDAN S?O TOM?AN SAHRAWI SAINT HELENIAN SAINT LUCIAN SAINT-PIERRAIS SALVADORIAN; SALVADORAN SAMOAN SAN MARINESE SAUDI ARABIAN SENEGALESE SERBIA AND MONTENEGRO SEYCHELLOIS SIERRA LEONEAN SINGAPOREAN SLOVAK SLOVENE SOLOMON ISLANDER SOMALI SOUTH AFRICAN SOUTH KOREAN SPANIARD SRI LANKAN STATELESS SUDANESE SURINAMESE SWAZI SWEDE SWISS SYRIAN TAIWANESE TAJIK TANZANIAN THAI TOGOLESE TOKELAUAN TONGAN TRINIDADIAN TUNISIAN TURK TURKMEN TURKS AND CAICOS ISLANDER TUVALUAN UGANDAN UKRAINIAN URUGUAYAN US VIRGIN ISLANDER UZBEK VANUATUAN VENEZUELAN VIETNAMESE VINCENTIAN WALLISIAN YEMENI ZAMBIAN ZIMBABWEAN

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Country AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA17 BOTSWANA BRAZIL BRITISH VIRGIN ISLANDS BRUNEI BULGARIA BURKINA FASO BURUNDI C?TE DIVOIRE CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO27 COOK ISLANDS COSTA RICA CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC REPUBLIC OF THE CONGO32 DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FAEROE ISLANDS FALKLAND ISLANDS FIJI FINLAND FORMER YUGOSLAV REPUBLIC OF MACEDONIA FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI45 KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR51 NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTH KOREA NORTHERN MARIANAS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN ISLANDS POLAND PORTUGAL PUERTO RICO QATAR R?UNION ROMANIA RUSSIA RWANDA S?O TOM? AND PR?NCIPE SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAUDI ARABIA SENEGAL SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SPAIN SRI LANKA STATELESS SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA THAILAND THE BAHAMAS THE GAMBIA TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY US VIRGIN ISLANDS UZBEKISTAN VANUATU VENEZUELA VIETNAM WALLIS AND FUTUNA WESTERN SAHARA85 YEMEN ZAMBIA ZIMBABWE

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State --- Please Select --- JOHOR KEDAH KELANTAN KUALA LUMPUR LABUAN MELAKA NEGERI SEMBILAN PAHANG PENANG PERAK PERLIS SABAH SARAWAK SELANGOR TERENGGANU WILAYAH PERSEKUTUAN Please select state

Country AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA17 BOTSWANA BRAZIL BRITISH VIRGIN ISLANDS BRUNEI BULGARIA BURKINA FASO BURUNDI C?TE DIVOIRE CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO27 COOK ISLANDS COSTA RICA CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC REPUBLIC OF THE CONGO32 DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FAEROE ISLANDS FALKLAND ISLANDS FIJI FINLAND FORMER YUGOSLAV REPUBLIC OF MACEDONIA FRANCE FRENCH GUIANA FRENCH POLYNESIA GABON GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI45 KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR51 NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTH KOREA NORTHERN MARIANAS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN ISLANDS POLAND PORTUGAL PUERTO RICO QATAR R?UNION ROMANIA RUSSIA RWANDA S?O TOM? AND PR?NCIPE SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAUDI ARABIA SENEGAL SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SPAIN SRI LANKA STATELESS SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA THAILAND THE BAHAMAS THE GAMBIA TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY US VIRGIN ISLANDS UZBEKISTAN VANUATU VENEZUELA VIETNAM WALLIS AND FUTUNA WESTERN SAHARA85 YEMEN ZAMBIA ZIMBABWE

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	• I / We* hereby declare that all information given in this application form and the attached documents are accurate and complete. • I / We* acknowledge that all documents submitted become the property of Wawasn Open University (WOU). • I/ We* consent that if registered, will conform to the Constitution and Rules and Regulations of WOU. • I / We* authorise WOU to obtain information from any of my previous or current educational institution/employer. • I / We* understand that WOU reserves the right to vary, reject or reverse any decision made on the basis of untrue, incomplete or misleading information. • I / We* agree to pay all fees due on the dates stipulated by WOU and that if I / we* default in paying the fees, the University has the right to take the necessary action as per the Constitution and Rules and Regulations of WOU. • In the event that WOU shall forfeit any fees, I / we* shall not have any claim whatsover against the University. • I / We* agree that WOU reserves the right to alter, amend, change or modify the current published fees and all fees payable shall be the published fees at the time of payment. • I / We* consent to the processing by the University of personal information and used in accordance with their policies as per the Privacy Statement published in the University’s corporate website (www.wou.edu.my) and the Personal Data Protection Act (2010). In the event I / we* do not agree or do not consent to the terms as contained herein, then WOU will not be able to provide the products and services to me / my child / my ward*. • I / We* consent to the use of my / my child’s / my ward’s* personal information in any publicity and /or promotional exercise within WOU including without limitation photographs / images or recordings, the publishing of examination results, the award of a prize or scholarship, any achievement, academic or otherwise. • I / We* understand and agree that WOU will not be held responsible for any damages, losses or injuries arising from the course of studentship with the University. • I / We* agree that WOU reserves the right to alter, amend, change or modify the University Constitution and Rules and Regulations without prior notice. • I / We* acknowledge that it is my responsibility to constantly update myself on the latest information embedded in the Student Handbook and other publications which can be retrieved from the Student Portal (https://my-i.wou.edu.my). • *whichever is applicable
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