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Diploma Admission Application

Select Program(*)
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Select Intake Year(*)
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Select Intake Month(*)
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Full Name (as per NRIC / Passport)(*)
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NRIC / Passport No.(*)
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Please enter your country citizenship.

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Date of Birth(*)
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Email Address(*)
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Mobile Number(*)
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Home Phone Number(*)
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Highest Qualification Obtained(*)
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Title of Qualification(*)
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Name of School Attended(*)
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Year Graduated(*)
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Current Designation(*)
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Emergency Contact Person(*)
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Emergency Contact Number(*)
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How did you first hear of us?(*)
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If "Others", please specify

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Last 3 years major medical history(*)
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Do you have any known major medical history where you have seen a specialist, in the last 3 years.

Medical History
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