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IMEC Online Application Form

GENERAL INFORMATION
 
* Please tick  where applicable
Course
IMEC English Intensive Program
Starter Elementary Lower Intermediate Upper Intermediate
 
Test
Advance Preparation of TOEFL / IEETS Test
 
Please tick course(s) applying for :
English Courses :
2 Months programme
3 Months programme
4 Months programme
5 Months programme
6 Months programme
 
Intake:
January March May July September November
February April June August October December
 
A :: PERSONAL PARTICULARS
(Please use BLOCK LETTERS and Underline Surname)
Full Name (As in IC / Passport)
Age
Date of Birth (DD/MM/YY) / /
Place of Birth
Sex Male Female
Marital Status Single Maried
Nationality Malaysian Other  
Passport NO / NIC NO
 
Permanent Address
City
State
Postcode / Zip code
Country
 
Contact Numbers
Home
Office
Fax
Handphone
Email

 
 
C :: ACADEMIC RECORD
School/Institute/College/University Description of Qualification Year of Completion
 
D :: ACCOMMODATION
Required       Not Required
 
G :: TERMS AND CONDITIONS FOR ENROLMENT
1 Fees
  1.1 International Student Registration Fee and Students Processing fee of RM 1250 must accompany all applications.
  1.2 For 1st payment, all fees must be made 7 working days prior to commencement of IMEC English Program. Subsequent monthly payment must be made before/at the 7th of the month, failing which a penalty of RM10.00 per day will be strictly imposed for each late payment.
  1.3 All payments should be made payable to “COUNTRY HEIGHTS EDUCATION SDN BHDâ€‌.
Malaysia Banks outstation cheque, please include bank commission of 0.03% of the cheque amount or minimum of RM0.50, whichever is greater. Payment can be paid by cash / Cheque (only applicable  for Malaysia Banks) / bank draft and/or by telegraphic transfer / direct banking to the following accounts:
 
Account Payee: COUNTRY HEIGHTS EDUCATION SDN. BHD.
Account Number: #1232-0000621-05-9
Swift code: #CIBBMYKL
Bank Name & Add: CIMB Bank
(Country Heights Branch)
Country Heights Kajang
43000 Kajang Selangor Darul Ehsan
Malaysia
   
  1.4 International Student Registration and processing fee are not transferable, non refundable and cannot be deferred.
  1.5 Any refund of fees, where applicable, will be at the discretion of the IMEC Finance Office.
     
2 Withdrawal
  2.1 Students must inform the Administration Department in writing if they are withdrawing from a program of study.
  2.2 Notice of withdrawal must be given fourteen days prior to the commencement of the program for a refund of tuition fee to be considered. The administrative charge for this is RM500.00
  2.3 Please note that in the event of a student failing to complete a program of study, IMEC is not obliged to return any part of the fees paid by or on behalf of the student.
     
3 Rules and Regulations
  3.1 All students must abide by IMEC Rules and Regulations. Failure to do so may result in expulsion, suspension, private or public sanctions.
  3.2 Any criminal activities on IMEC premises will be reported to the relevant authorities.
  3.3 The Disciplinary Board has the authority to suspend or/and expel any student behaving in a manner that affects the good name and security of its staff and students.
  3.4 IMEC reserved the right to revise the rules and regulations without prior notice.
  3.5 IMEC reserves the right to accept or reject any application without assigning any reason.
 
 
H :: DECLARATIONS
Declare that to the best of my knowledge, the information given in this application form is complete, accurate and true. If accepted to this course, I agree to abide by the above terms and conditions. I understand that any information given falsely or withheld could affect the decision of my application, and may result in my ineligibility for admission or enrolment, and/or if discovered at a later date, my course and visa will be terminated by IMEC.
Yes, I agree Date (DD/MM/YY) : / /
 
DECLARATION BY PARENT / GUARDIAN IF APPLICANT IS BELOW 21 YEARS OLD
I, hereby undertake to guarantee the good conduct of the above applicant while studying at IMEC. I also agree to pay all fees due to IMEC on his / her behalf in accordance with the policies of COUNTRY HEIGHTS EDUCATION SDN BHD.
Yes, I agree of Parent / Guardian Date (DD/MM/YY) : / /
Name
Relationship