STUDENT STATUS MODIFICATION FORM

COMPLETION : COMPLETION OF STUDY AND APPLICATION FOR REFUND OF DEPOSITS

WITHDRAWAL : CESSATION OF STUDY AND APPLICATION FOR REFUND OF DEPOSITS
DEFERMENT : APPLICATION FOR LEAVE OF ABSENCE
TRANSFER : APPLICATION FOR TRANSFER OF PROGRAMME/INTAKE/STUDY MODE
Important information: 1) Kindly complete this form with Adobe Acrobat 6.0 version or higher; and
2) Please do not alter the contents and formatting of this form.
PERSONAL AND PROGRAMME PARTICULARS
Name
(As in NRIC/Passport)
NRIC/Passport No. Student ID
Contacts Mobile No.: Personal Email:
Programme Intake
Student Pass Expiry Date
Nationality
(For International Student only)

STUDY STATUS PARTICULARS (Please choose and state the details of your application)
□ Completion □ Transfer □ Programme (Please specify)
□ Withdrawal □ Intake (Please specify)
□ Deferment From To □ Study Mode (Please choose) □ Full Time □ Part Time
(MM-YYYY) (MM-YYYY)

REASON(S) (Please choose the most applicable reason)

Academic Transfer Financial Personal Others
Progressing to Higher Level at Sunway Transfer to Other Institution (Articulation Arrangement) Financial Difficulties Health Issue Self-study Currently Working
Programme: Institution Name: Received Scholarship Elsewhere
Family Issue Friend Issue Seek Employment
Unable to Cope with Programme Programme Local Foreign
Difficulty with Level of English Taking a break Student Visa Issue
Transfer to Other Institution (Non-Articulation Arrangement)
Staff Issue
Difficulty with Maths Components Change of Interest
Institution Name: Academic Staff Issue
Did not Meet Entry Requirements
Programme: Administrative Staff Issue Return to Home Town/Country Others
Do not Prefer Online Learning

REFUND PARTICULARS [For Completion/Withdrawal only. Please specify the payment option for refund (subject to bank charges)]
□ Donate □ ALL □ RM ____________ to Jeffrey Cheah Foundation. Tax Exemption Reference: LHDN.01/35/42/51/179-6.6370
□ By Cheque □ Crossed cheque □ Open cheque (only applicable to International students with no local bank account)
By IBG/ Bank
□ Account No.
Telegraphic Transfer (Please state name, branch and country)

*only applicable for overseas bank account Currency* Swift Code* IBAN No./BSB Code/ IFSC Code* (if applicable)

Please specify the payee for refund

□ Self □ Father □ Mother □ Guardian (as specified in your application form)
Name NRIC/Passport No.
Please specify the collection method for refund by cheque or Official Receipt for donation to Jeffrey Cheah Foundation
□ Collect personally or by the payee (only applicable to International students) □ Post by mail [Please provide full address. (Note: overseas address using P.O. Box is not allowed)]

□ Collect on behalf of payee (Note: A letter of authorisation is required)

IMPORTANT NOTES AND MANDATORY DECLARATION

Completion/Withdrawal Transfer
1. Application for refund must be made within 12 calendar months from your last day of study. 1. You must meet the requirements of the new programme.
2. In the case of withdrawal, the return of your student ID card is mandatory if one has been issued 2. The return of your student ID card is mandatory if one has been issued to you, failing
to you, failing which a penalty of RM47.00 will be imposed respectively. which a penalty of RM47.00 will be imposed respectively.
3. All Sunway University equipment/property in your possession (e.g. books borrowed from the 3. You must continue attending classes/lessons in the current programme until you have
Sunway Campus Library) must be returned to the relevant departments. received a letter confirming your transfer.
For International Student Eligibility Criteria
- International Student (student pass holder) must perform student pass cancellation/shortening You are eligible to apply for completion/withdrawal/deferment/transfer if:
within 30 days after the completion/withdrawal of studies. Failure to comply, International Office - You do not have any outstanding payment with Sunway University; and
will proceed to notify the respective Higher Authority in Malaysia for their further action. - You are fully aware and accept that you will comply with the rules and regulations of
- Refund of deposit (s) will only be processed when student submit this form and relevant Sunway University.
supporting documents such as confirmed air-ticket to your home country or Offer Letter for the
next institution in Malaysia. Please submit accordingly to avoid any delay in the refund processing. 3URFHVVLQJ7LPH
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Deferment - Approximately 20 working days upon confirmation of completion/withdrawal of
1. Application has to be made BEFORE the commencement of the study period you wish to defer. programme (excluding Saturday, Sunday and public holidays).
2. A deferment is normally granted for a period of ONE semester. The total period of deferment Deferment/Transfer
allowed for a programme is ONE calendar year, after which you will be required to withdraw from - Approximately 7 working days from the submission date of this form (excluding
the programme. Saturday, Sunday and public holidays).
For International Student
Supporting Documentation
- You must submit a copy of your confirmed air-ticket to your home country.
- Upon arrival at your home country, you are required to scan the exit stamp in your passport □ I enclose a letter/copy of air-ticket/other supporting document(s) for this application.
(latest exit date from Malaysia) and send via email to the International Office at Please read the following carefully and sign and date here before submitting this form to:
[email protected]. Registry (Malaysian Student) or International Office (International Student)
- International Student (student pass holder) must submit original passport for the student pass I hereby undertake that I am fully aware of and will be bound by the Sunway University rules
cancellation/shortening before you can submit this form. and regulations for this application.
- International Student (student pass holder) who is applying for deferment for more than two (2) I declare that all the particulars relate to me and are correct.
consecutive semesters are required to perform student pass cancellation/shortening before
returning to home country.
- Deferment can be considered for medical reasons and for valid reasons (extenuating Signature
circumstances) that prevent the student from engaging appropriately with the programme
provided that the student consults International Office prior to putting in the deferment Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable
application. It is the responsibility of the international student to obtain the prior approval from (depending on the Acrobat version used during completion of this form).
International Office with regards to this matter. Name Date 1
-(Version: 10032022)
 FOR OFFICE USE ONLY
FOR ALL PROGRAMMES EXCEPT POSTGRADUATE BY RESEARCH PROGRAMMES (This section must be endorsed by a senior staff member from the relevant School or Academic Department)
Department)
Approval from School / Academic Department (NEW programme) Approval from School / Academic Department (CURRENT programme)
[Only applicable for students who are transferring programme]
□ Approved □ Approved
□ Full Offer Remarks
□ Conditional Offer (with the following conditions)
□ Actual results to meet programme entry requirements
□ Produce original academic documents for verification
□ Other conditions (please specify)
Note: Remarks in this section will be considered as official and entered into EMX
□ Not Approved [please specify reason(s) for rejection] □ Not Approved [please specify reason(s) for rejection]

Signature Signature
Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable (depending on the Acrobat Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable (depending on the Acrobat
version used during completion of this form). version used during completion of this form).
Name Name
Date Date
Approval from Centre for English Language Studies (For students who are enrolled in the Intensive English Programme and one other programme)
Remarks Signature
Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable (depending on the Acrobat
version used during completion of this form).
Name
Date
FOR POSTGRADUATE BY RESEARCH PROGRAMMES ONLY (This section must be endorsed by a senior staff member from the relevant School or Academic Department)
Decision by the School (NEW programme) Decision by the School (CURRENT programme)
[Only applicable for students who are transferring programme]
Head of Department Head of Department
□ Supported □ Not Supported □ Supported □ Not Supported
Comments (if any): Comments (if any):

Signature Signature
Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable (depending on the Acrobat Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable (depending on the Acrobat
version used during completion of this form). version used during completion of this form).

Name Name
Date Date
School Dean School Dean
□ Recommended □ Not Recommended □ Recommended □ Not Recommended
Comments (if any): Comments (if any):

Signature Signature
Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable (depending on the Acrobat Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable (depending on the Acrobat
version used during completion of this form). version used during completion of this form).
Name Name
Date Date
Approval by the Chair of University Research Degrees Committee (URDC)
□ Approved □ Not Approved
Comments (if any):

Signature
Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable (depending on the Acrobat version used during completion of this form).

Name
Date
INTERNATIONAL OFFICE [Please indicate with a tick (√)] THE REGISTRY [Please indicate with a tick (√)]
□ Return of student ID card (for withdrawal/transfer programme/intake only) □ Return of student ID card (for withdrawal/transfer programme/intake only)
□ Returned □ Not Returned □ Returned □ Not Returned
□ Updated status in the EMX □ Updated status in the EMX
□ Updated student pass □ Printed and issued letter of notification (not applicable for completion)
□ Verified air-ticket □ Printed and issued new student ID card (for transfer programme/intake only)
□ Verified passport (included all stamped pages; for cancellation of student pass) □ Printed and issued letter of offer (M’sian student for transfer of programme/intake only)
□ Received a copy of the passport information page
□ Received a copy of the passport entry stamp/offer letter
□ Printed and issued letter of offer (Int’l student for transfer of programme/intake only)
Remarks Remarks

Signature Signature
Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable (depending on the Acrobat Important: Before signing, please enter your Name and Date below. Once signed, form may no longer be editable (depending on the Acrobat
version used during completion of this form). version used during completion of this form).

Name Name
Date Date
For enquiries please call +603 7491 8622
• Malaysian student: Extension 8772/8137 (for all programmes)
• International student: Extension 3824 (for all programmes)
Or send an email to [email protected] (please provide your name as in NRIC/Passport, student ID number, programme and intake).
Data protection
The protection of personal data is an important concern to Sunway University and any personal data collected on this form will be treated in accordance with the Personal Data Protection Notice of the
institution [http://sunway.edu.my/pdpa/notice_english (English version) or http://sunway/edu.my/pdpa/notice_BM (Malay version)].
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