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DCAM Part 66 Module Examination Application Form
APPLICANT DETAILS
Name:
Student ID:
NRIC / Passport No:
E-Mail:
Contact No:
Program:
Category Applied
Tick box if first time sitting for the applied module examination.
Date of previous module exam sitting if this is not the first sitting
EXAMINATION MODULES
Note: Students are only allowed to apply for one (1) module at any one (1) time.
Consolidation class date confirm
Examination date confirm
Mark where
(if first exam sitting)
Modules
(For
UniKL MIAT use only)
applicable
(For UniKL MIAT use only)
Module 1
Module 2
Module 3
Module 4
Module 5
Module 6
Module 7
Module 8
Module 9
Module 10
Module 11A
Module 11B
Module 12
Module 13
Module 14
Module 15
Module 16
Module 17
I wish to apply for the examination module as indicated and confirm that the information contained in this form is
correct at the time of application. Copies of Student ID and related examination result slip are attached. I also confirm
that at the date of this application, Im not being barred from taking module examination.
Signature: _______________________________
Exam Fee Received
Consolidation Class Fee
Received (if applicable)
Signature
RM
RM
Date: _________________________
Receipt Number
Receipt Number
Date
Criteria
Student has passed the necessary UniKL MIAT Subject relevant to the Module
Examination applied as per the checklist provided.
Students have undergone consolidation class for the module examination applied and
achieved 100% attendance.
Student is not being barred from taking any module examination.
For student who is re-sitting the module examination, 90 days have passed since the
previous module examination. For student who re-enrolls in the consolidation class, 30
days have passed since the previous module examination.
Mark where
applicable
Module 7
Module 8
Module 9
Module 10
Module 11A
Module 11B
Module 15
Module 16
Module 17
Mark if student
have passed the
subject.
Module 7
Module 8
Module 9
Module 10
Module 12
Module 15
Module 16
Mark if student
have passed the
subject.
Module 1
Module 2
Module 3
Module 4
Module 5
Module 6
Module 7
Module 8
Module 9
Module 10
Module 13
Module 14
Mark if student
have passed the
subject.
Module 7
Module 8
Module 9
Module 10
Module 11A
Module 11B
Module 15
Module 16
Module 17
Mark if student
have passed the
subject.
Module 13
Module 14
Mark if student
have passed the
subject.
Module 7
Module 8
Module 9
Module 10
Module 11A
Module 11B
Module 15
Module 16
Module 17
Mark if student
have passed the
subject.
Module 6
Module 7
Module 8
Module 9
Module 10
Module 11A
Module 11B
Module 15
Module 16
Module 17
Mark if student
have passed the
subject.
Module 5
Module 6
Module 7
Module 8
Module 9
Module 10
Module 13
Module 14
Mark if student
have passed the
subject.