Online Registration Form

1. Personal Details
2. Full Name(required)
3. NRIC / Passport No.
4. Email Address(valid email required)
5. Gender
6. Male Female
7. Race -- Select Race -- Chinese Indian Malay Others
8. Place of Birth
9. Secondary School Attended(required)
10. Contact Details
11. Permanent Home Address
12. Postcode
13. City
14. State
15. Country -- Please select a country -- Afganistan Albania Algeria American Samoa Andorra Angola Anguila Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerjaijan Bahamas Bahrain Bangladesh Barbados Belarus Belguim Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guadaloupe Guam Guatamala Guinea-Bissau Guinea Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (north) Korea (south) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malaysia Malawi Maldives Mali Malta Marshal Islands Martinique Mauritania Maurritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Mynamar Namibia Nauru Nepal Netherland Antilles Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Marianas Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobego Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe Other
16. Telephone No. (House)
17. Telephone No. (Mobile)(required)
18. Parents/Guardian Detail
19. Full Name(required)
20. NRIC / Passport No.
21. Race -- Select Race -- Chinese Indian Malay Others
22. Telephone No. (House)
23. Telephone No. (Mobile)(required)
24. Ocuppation
25. Company Name
26. Company Address
27. Permanent Home Address
28. Postcode
29. City
30. State
31. Country -- Please select a country -- Afganistan Albania Algeria American Samoa Andorra Angola Anguila Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerjaijan Bahamas Bahrain Bangladesh Barbados Belarus Belguim Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guadaloupe Guam Guatamala Guinea-Bissau Guinea Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (north) Korea (south) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malaysia Malawi Maldives Mali Malta Marshal Islands Martinique Mauritania Maurritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Mynamar Namibia Nauru Nepal Netherland Antilles Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Marianas Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobego Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe Other
32. Academic Qualification
33. Year
34. School/ College/ University
35. SPM Result
36. Bahasa Malaysia
37. English
38. Mathematic
39. Pendidikan Seni
40. Pendidikan Islam / Moral
41. Sejarah
42. STPM Result
43. Bahasa Malaysia
44. English
45. Kesusteraan Melayu
46. MUET
47. Last School Attended
48. University / College
49. Degree / Diploma / Certificated Field
50. CGPA
51. Selection of Programme
52. Programme Diploma in Graphic Design Diploma in Interior Design Diploma in Interactive Multimedia Design Diploma in Industrial Automation (Mechatronics) Certificate of Art & Design Professional Short Course
53. Scholarship for Eligible Applicant
54. Scholarship Not Eligible PIA Merit Scholarship PIA B40 Scholarship PIA Athletic Scholarship
55. Financial Aids for Eligible Applicant
56. Financial Aid Not sure PIA Installment Scheme PTPTN PTPK Perak State Education Loan EPF Account 2 Withdrawal Kojadi

57. ---

    
    REGISTRATION
    
    You are required to pay a non-refundable registration fee of RM650.
    
    Online transfer or bank in into:
    
    Bank Name:                 CIMB BANK BERHAD
    Bank Account Name: PIA ARTS & DESIGN SDN BHD
    Account Number:       8005034664
    
    Email us proof of payment to finance@pia.edu.my
    OR
    Whatsapp to us at +6016 888 9639
    
    Contact us if you have any question. Terms & conditions apply.

 

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