Create Student Admission

PROGRAMME DETAILS

Programme Name

PERSONAL DETAILS

Full Name As per NRIC / Passport MRZ

First Name

Last Name

Nationality Please select your nationality

Date of Birth

Place of Birth

Age will be calculated from Date of Birth

Gender

Race

Religion

Contact Number (Mobile) (Start with Country Code, Followed with Mobile Number)

Email Personal Email Address

Disability

Known Disability Specif if There's An Mental / Phsical Illness

Do you have Dual Nationality?

Second Nationality

I am not CAO Eligible

ADDRESS DETAILS

Address

Postal Code

City

State

Country

AGENCY DETAILS

Do You Have An Agency Representative

Agency Name

Agency Email

Have you been in touch with one of our course counsellors

Counsellor Name

EMERGENCY CONTACT DETAILS

Emergency Contact Details

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Emergency Contact Occupation

Secondary Emergency Contact

Secondary Emergency Contact Name

Secondary Emergency Contact Relationship

Secondary Emergency Contact Phone

Secondary Emergency Contact Occupation

Family Income

Monthly Family Income Category

Monthly Gross Family Income (MYR)

EDUCATION DETAILS

Current Education

Education Level

Certificate Name

Institute Name

Completion Date (Month/Year) Completion Date or Expected Completion Date. Ex: 01/2022

Secondary Education

Education Level

Certificate Name

Institute Name

Completion Date (Month/Year) Completion Date or Expected Completion Date. Ex: 01/2022

Subject List (5 compulsory subjects) with grades:

Subject	Grade
Biology
Chemistry
Mathematics or Additional Mathematics
Physics
Other Subject

English Proficiency Test

Certificate Type

Certificate Name

Overall Results

Component Results (if applicable):

Writing

Reading

Listening

Speaking

Date

Must be less than 2 years validity at the time of admissions and taken in one seating.

DOCUMENT TO UPLOAD

Recent Photograph

Pdf and image file are accepted

Current Education Certificate/Transcript (Official/Terms/Predicted)

Only Pdf file are accepted

Secondary Education Certificate/Transcript (if applicable)

Only Pdf file are accepted

English Proficiency Test Certificate

Only Pdf file are accepted

CV/Resume

Only Pdf file are accepted

Personal Statement

Only Pdf file are accepted

ADDITIONAL INFORMATION DETAILS

Have you ever been discontinued from an academic institution

Please state the reason why you have been discontinued

I would like to be considered for RUMC Undergraduate Scholarship

I am not bonded/ sponsored by any institutions/ organization

I understand that providing false or misleading information may result in withdrawal or discontinuation from the programme.

I declare that all information provided is true and accurate.

PAYMENT DETAILS

Payment Code

*If you have a valid payment or waiver code, please enter it here. Once validated, no additional payment will be required. If the code is invalid, our Admissions team will contact you to arrange the RM500.00 application fee.

RCSI & UCD Malaysia Campus

Application Form 2025/26

PROGRAMME DETAILS

PERSONAL DETAILS

ADDRESS DETAILS

AGENCY DETAILS

EMERGENCY CONTACT DETAILS

Emergency Contact Details

Secondary Emergency Contact

Family Income

EDUCATION DETAILS

Current Education

Secondary Education

Subject List (5 compulsory subjects) with grades:

English Proficiency Test

Component Results (if applicable):

DOCUMENT TO UPLOAD

ADDITIONAL INFORMATION DETAILS

PAYMENT DETAILS