Name :    (Please state Mr/Mdm/Ms)

Address :

Home Address : 

Office Address :

Phone Number (Home/Office): 

Hand Phone Number : 

Email Address : 

Age : 

Present Occupation : 

Please answer the following questions: Kindly click on the relevant column

1. Would you like to enrol as a student with Wawasan Open?	Yes  No
2. Do you have a Sijil Rendah Peperiksaan/ Pemeriksaan Menengah Rendah (SRP/PMR) which is a Form 3 Certificate?	Yes  No
3. Do you have a Sijil Persekolahan Malaysia (SPM) which is a Form 5 School Certificate or equivalent?	Yes  No

4. Please click on the area(s) you would be interested in:
Banking & Finance
Sales & Marketing
Accounting
Business Information Systems
Logistics & Supply Chain Management
Management
Electronic Commerce
Computer Systems & Network
Computing & Intelligent Systems
Information & Communications Technology
Electronics