BORANG MELAPUR DIRI (TAMAT PENGAJIAN) REPORT FOR DUTY FORM (COMPLETED STUDIES)

Nama/ Name :________________________________________________________

No. Kad Pengenalan/ IC No. :___________________________________________________ Jawatan/ Position: ___________________________________________________________

Unit Bahagian/ Department: ___________________________________________________

1. KURSUS PENGAJIAN / PROGRAMME OF STUDY :- a. Nama Kursus / Course Name :_________________________________________

b. Pusat Pengajian / Institution :__________________________________________

c. Jenis Tajaan / Type of Sponsorship : Sepenuh Masa / Separuh Masa / Pinjaman

Full time/ Part time/ Loan

d. Keperluan Pembelajaran / Study Programme Requirement : Kerja Kursus/ Coursework Tesis/ Thesis Kerja Kursus dan Tesis / Coursework and Thesis Lain-lain / Others ___________

e. Untuk pembelajaran melalui tesis , sila nyatakan tajuk tesis yang dihantar / For

Thesis study , please state the title of thesis submitted:______________________ ___________________________________________________________________

f. Status Pembelajaran: Tamat / Belum Tamat / Gagal

Completed / Not Completed / Fail

g. Jika pengajian anda belum tamat atau gagal, sila nyatakan sebab/ If your study is not yet complete or fail , please indicate your reason: ________________________ ___________________________________________________________________

h. Jika pengajian anda lulus, nyatakan jenis Ijazah yang diperolehi / If your study is successful, please name the Degree that has been awarded to you :___________________________________________________________________

Gred / Grade: _____________CGPA Akhir/ Final CGPA :______________________

i. Program Luar Negara sahaja/ Oversea Programme only

Tarikh pulang ke Malaysia/ Date of return to Malaysia:_______________________

2. DOKUMEN- DOKUMEN TAMBAHAN YANG PERLU DIKEMUKAKAN:- THE SUPPORTING DOCUMENTS THAT NEED TO BE SUBMITTED

a. 1 Salinan Sijil Ijazah / a copy of Degree

Certi�cate ( )

b. 1 Salinan Transkrip / a copy of Transcript

( )

c. 1 Salinan Tesis atau Disertasi / a copy of Thesis or Dissertation

( )

d. 1 Salinan Surat Pengesahan Tamat

Pengajian/ a copy of Letter of Completed Studies

( )

Semua salinan dokumen-dokumen ini perlu dikemukakan kepada YTM untuk tujuan rekod/ All the supporting documents need to be submitted to YTM for record purposes

3. AKUAN PENERIMAAN (Untuk Urusan YTM sahaja) ACKNOWLEDGEMENT OF RECEIPT ( For YTM use only)

Tandatangan/ Signature :…………………………………………………........

Tandatangan/ Signature :…………………………………………………........

Tarikh/ Date :…………………………………………………........

Nama Pegawai/ O�cer Name :…………………………………………………………..

Jawatan/ Position :………………………………………………………..

Tarikh Terima/ Date of Received:…………………………………………………………