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Application Details
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Applicant Name *
Please complete your name as it appears on your University record
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Applicant Date of Birth *
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Correspondence Address *
This should be your current place of residence
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If providing an international number, please include the international dialing code (e.g. the code for India is +91)
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If you have a Newcastle University email account, please use this email address.
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Applicant Course Details
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Have you applied for, or been awarded funding from any other sources? *
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Details of your relative
Please complete whether your relative has graduated or currently studying at Newcastle University Medicine Malaysia
The following section solely relates to your relative.
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Name of Relative *
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Date of Birth *
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This must be a close family member e.g. husbands & wives, brothers & sisters, fathers & mothers, sons & daughters.
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Date of Graduation (if they have graduated)
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Applicant declaration
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I confirm that I have read and understood the regulations and confirm that the information I have given is correct to the best of my knowledge *
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Date *
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Please enter today's date
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Once this form is complete, please use this section to upload the required evidence for your application.
Use numerous 'Browse...' links to upload multiple documents if required.
E.g. relevant Degree Certificates, Marriage / Birth Certificates etc
For siblings, Birth Certificate are preferred.
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Data Protection Statement
The University will retain information supplied on this form for a maximum of three years. This information will be accessible to staff in Finance Section only
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