*NOTA (Note): Jangan lampirkan dokumen asal. Semua salinan dokumen hendaklah DISAHKAN oleh Pegawai Kerajaan Kumpulan A / Pengetua Sekolah/ Wakil Rakyat/ Penghulu/ Pesuruhjaya Sumpah/ Peguambela & Peguamcara/ Setaraf. (Please do not attach the original documents. All copies of documents have to be CERTIFIED TRUE COPY by Group A Government Officer/ School Principal/ State Assembly-Man/ Penghulu/ Commisioner of Oath/ Advocates & Solicitor/ equivalent)    
SECTION 1 : PROGRAM APPLIED
Date Of Intake:
Programme* :
   
SECTION 2 : PERSONAL BIODATA
   
Name* :
IC No.* :
(eg: 8501030019999)
Permanent Address :
 
City :
State :
Post Code:
Country :
Telephone (House):
Handphone* :
Marital Status :
Date of Birth :
Gender :
Religion :
Race :
   
Email* :
 
SECTION 3 : PARENTS/GUARDIANS DETAILS
Name :
IC No.:
(eg: 8501030019999)
Occupation :
Address :
 
City :
State :
Post Code:
Country :
Telephone (House):
 Handphone :
Monthly Household Income (RM):
   
SECTION 4 : ACADEMIC BACKGROUND
Type of examination :
 
SPMV
 
STPM
 
OTHERS
Year :
No. of Subject Taken :
   
Subjek SPM : Grade
   
 
Subjek STPM: Grade
   

* Syarat minimum kemasukan ke program Sijil hendaklah lulus SPM/SPMV/Setara dengan 3M membaca, menulis,mengira

** Syarat minimum kemasukan ke program Diploma hendaklah lulus SPM/SPMV/Setara dengan 3 kredit termasuk mana-mana subjek Sains Tulen (Biologi/Fizik/Kimia)/ Sains atau Setaraf.

   
   
SECTION 5 : EDUCATION BACKGROUND
Name of the School :
Address :
 
 
   
Entry Date :
 
 
Leave Date :
 
 
SECTION 6 : DECLARATION

Saya mengaku bahawa sepanjang pengetahuan saya, maklumat yang saya berikan adalah tepat dan benar. Saya juga faham bahawa sekiranya terdapat sebarang bentuk pemalsuan maklumat, pihak Kolej berhak menolak permohonan ini, menarik kembali tawaran atau menamatkan pengajian saya pada bila-bila masa.
(I hereby declare that the information contained herein is complete and accurate to the best of knowledge. I fully understand that withholding or giving false information, the college has the right to reject or revoke my application or terminate my studies at any times)

Name* :
Date  (dd-mm-yyyy)* :
- -
NOTE :
Kindly take note that the processing fee and the documents required should reach the Addmission Office within one week of this submission or by the deadlines mentioned whichever is earlier.
© Hak Cipta Terpelihara Kolej Sentral.
Warisan Jengka Education Sdn.Bhd., ARAS TANAH, WISMA WARISAN,26400 BANDAR TUN ABDUL RAZAK JENGKA, PAHANG,
NO TEL : 09-4677 777, 09-4675 077 H/P : 013-9331918 FAX : 09-4676 777