Re-Enrolment/Change of Enrolment Form
Intensive English Program
Course Code: IEP
Please note : You are required to enrol by the designated enrolment deadlines.
ALL FORMS SUBMITTED TO STUDENT SERVICES COUNTER AFTER LAST DATE FOR RE-ENROLMENT WILL BE
CHARGED RM 100 FOR LATE ENROLMENT.
PERSONAL DETAILS
Curtin Student ID Miri ID
Family Name Given Name
Date of Birth Contact Number
UNIT ENROLMENTS AND WITHDRAWALS
Level (Elementary / Intermediate / Upper Enrol (E) /
Year (eg 2011) Term (eg Term 4)
Intermediate / Advanced Level) Withdraw (W)
STUDENT DECLARATION: I hereby certify that the information provided on this form is complete and
correct. While I am a student of the University I undertake to observe all its statutes, by-laws, rules and
instructions.
/ /
Student’s Signature Date
OFFICE USE
Authorizing HOD / Coordinator’s Name ____________ ______
Authorizing HOD / Coordinator’s Signature ________ Date: _____/______/______
Unit Coordinator (or other staff) Comments
IF YOU STILL HAVE THIS FORM IN YOUR POSSESSION YOU ARE NOT ENROLLED.
THIS FORM MUST BE LODGED WITH THE ENROLMENT OFFICE AT STUDENT SERVICES
DEPARTMENT.
Enrolments Office : UD/ ______________ Date Received:
(When record in the system is updated {UD})