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
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Staff ID No *
example : 001234
Full Name *
Example : Caroline John 
I/C / Passport No *
Example : 990101-13-1234 (IC Number)  or A1234567 (International Passport)
Telephone No *
e.g +60 - 13 444 4444 / +60 85 443939 (House No)
Address *
e.g. Lot 123, Taman Setia, Kuala Lumpur
Faculty (for academic staff only)
e.g. Faculty of Business
Clear selection
Department (for professional staff only)
e.g. Department of Marketing
Personal Email *
e.g. or
Clear form
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