Application For Study

The Faculty of Homeopathy Malaysia - FAHOM ( Rgt)
Fakulti Perubatan Homeopathy Malaysia
Main Campus: 122 Taman University, Gelang Mas, Meranti, 17010 Pasir Mas, Kelantan.
Tel: 019 9401915 E Mail: fahom2009@gmail.com
Web: www.homeopathymalaysia.org.my

Faculty of Homeopathy Malaysia – Centre For Continuing Education – FAHOM –CfCED
Pusat Pendidikan Berterusan _ Fakulti Perubatan Homeopathy Malaysia

Application Form Homeopathic / Acupuncture Course

Nature of Course: Certificate , Diploma, Bachelor, Master………………………………………..

Name of Applicant:……………………………………………………………………………………………………..
Postal Address:…………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………
Tel: Home:…………………………………………………….Mobile:………………………………………………
E Mail:………………………………………………………………………………………………………………………..
Web / blog:…………………………………………………………………………………………………………………
Date of Birth:………………………………………I/C or ID…………………………………………………………
Place of Birth………………………………………………Citizenship:…………………………………………….
Qualification: Academic & Professional: Name of Certificate, Diploma or Degree. Name of school
or college obtained and year of qualification.
1. Name of Certificate:……………………………………………………………………………….Year…………………...
Name & Address of School:……………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………….
2 ……………………………………………………………………………………………………………………….Year……………………….
Kindly attach photocopy of all your qualification to support your application.
1. 3 passport size photos.
2. Photocopy copies of academic and professional qualification.
3. Testimonial / Recommendation letter from any VIP


Acceptance Of Offer Form:

I hereby confirm that I agree to attend the programme of study as mentioned above and I will abide to all rules and regulation as governed by the management of FAHOM and Unit T/CM Ministry of Health Malaysia throughout the duration of my studies.
I understand that the programme of study is provided specifically for those who wish to enhance their knowledge and skill and traditional medicine especially homeopathy.

I understand that the programme of study is not listed as programmed recognized by Public Service Department ( PSD) for any appointment. This programme of study is also not listed as programmes recognized by any professional or certified bodies either local or abroad. I also understand that generally, this programme of study is not listed as a qualification for entry to any local universities unless given special consideration by the university.

I agree that FAHOM has the right to withdraw or terminate this offer if the information or statement given by me in this application are false.

I agree that FAHOM has the right to terminate my studies, at any time, without assigning any reason.

Date of applicant:……………………………….. Signature:……………………..………………………………….
Name:………………………………………………………………
I/C No…………………………………………………………………
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For Official Use:

Name of Student:………………………………………………………………………………………………………………………
Date Received:……………………………………………..Date Reply:………………………………………………………….
Approved / Rejected: Date of Meeting:……………………………………………………………………..
Reason:……………………………………………………………………………………………………………………………………..

Please Note: If the application is rejected, the college will refund all fee paid with 2 weeks from the date of receiving.

Board of Faculty of Homeopathy Malaysia

Sig. Registrar………………………………………………………… Director…………………………………………………..
Member ofSenate:………………….....................Member…………………………………………