SA1 – Hostel Application – Student Portal

Personal Details
Name*
Race*
Religion*
Nationality*
Date of Birth*
Gender*
Martial status*
Place of Birth*
Identity Card No.
Identity Card Colour
Passport No.
Programme Details
Registration ID No.
Faculty / Centre
Programme
Year of study
Scholarship status
Scholarship Type
Contact Details
Email*
UNISSA Email
Address (Brunei)*
Address (Home Country)
Telephone No. (Home)
Telephone No. (Mobile)*
Guardian's Details
Guardian's 1 Name*
Guardian's 1 Contact No.*
Guardian's 2 Name
Guardian's 2 Contact No.
Contact Person In Case Emergency
Name*
Relation*
Address*
Telephone No. (Home)
Telephone No. (Mobile)*
Telephone No. (Office)
Attachment
copy of identity card(local students), copy of passport(international students)
Drop files here or
copy of UNISSA student card
Drop files here or
Pembayaran dibuat selepas pelajar disahkan dan diterima masuk ke kolej kediaman
Type of room
Click here to view type of room!
Student Declaration
Date*
Date Format: DD slash MM slash YYYY
*
- I hereby verify that all information on this form is true and correct to the bes t of my knowledge.

Personal Details