Curtin Staff Registration
Patron Registration Form
I consent to the collection, use, processing, disclosure and retention by Curtin University and Curtin Sarawak of my personal data (and any sensitive personal data as defined by the Personal Data Protection Act 2010, where applicable) under the terms of Curtin University’s Privacy Policy and the Personal Data Protection Act 2010 in Malaysia.
* Required
Staff ID No *
example : 001234
Your answer
Full Name *
Example : Mohamed Firdaus
Your answer
I/C / Passport No *
Example : 001122-13-5566 or A1234567 (International Passport)
Your answer
Telephone No *
e.g +60 - 13 456789 (HP) / +60 85 443939 (House No)
Your answer
Address *
e.g. Lot 123, Taman Setia, Kuala Lumpur
Your answer
Faculty (for academic staff only)
e.g. Faculty of Business
Department (for professional staff only)
e.g. Department of Marketing
Your answer
Email *
Your answer
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