Application Form - Executive Short Courses

Read and follow the instructions carefully prior to submitting your application here. All awardees will be notified via e-mail.

Read and understand the instructions.

Yes, I have read and understood the instructions outlined above.

If selected, you will be asked for documentation to support the data you have provided. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.

I. Personal Data

Tell us about yourself.

Full Name

Birthdate

Age

Mobile No.

IC No.

E-mail

Where the confirmation will be sent to

Home Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Gender

Male
Female

Race

Religion

Nationality

Marital Status

Married
Single
Others

II. Academic Background

Highest Education Level

Major Area of Study

Name of Institution

Year of Completion

III. Current Employment

Employer

Designation

Description of your work including your responsibility

IV. Desired Programme Details

Programme / Course

Institution

Course Fee

Programme Brochure

(Max File Size 1MB. Supported file formats: *JPG. *JPEG, *PNG, *PDF, *TXT, *DOC, *DOCX)

Additional Information

V. Extras

Recent Photo

(Max File Size 1MB. Supported file formats: *JPG. *JPEG, *PNG, *PDF, *TXT, *DOC, *DOCX)

Updated CV

(Max File Size 1MB. Supported file formats: *JPG. *JPEG, *PNG, *PDF, *TXT, *DOC, *DOCX)

VI. Essay

Explain why you are applying for this course / programme, what you hope to learn from it, and how will it benefit your professional development and your organisation (300 - 500 words).

Essay

(Max File Size 1MB. Supported file formats: *JPG. *JPEG, *PNG, *PDF, *TXT, *DOC, *DOCX)

I hereby accord consent to process my personal data provided in accordance to your Privacy Notice in compliance with the Personal Data Protection Act 2010 (Act 709).

Submit

Our Contact Information

Yayasan Khazanah
Level 2, Block A,
Dataran PHB,
Saujana Resort, Section U2,
40150 Shah Alam, Selangor.

Tel : +603 - 5870 4333
Fax : +603 - 5870 4355

yk@yayasankhazanah.com.my