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UNIT PSIKOLOGI DAN KERJAYA

BORANG PERMOHONAN FASILITATOR


MINGGU SUAI KENAL (MSK) SESI JUN 2013
ARAHAN: SILA ISI BORANG INI DENGAN JUJUR
PERIBADI
NAMA

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NO. PENDAFTARAN

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PROGRAM/ JABATAN

: ...................................................................................................................

NO.K/PENGENALAN

: ...................................................................................................................

NO. TEL BIMBIT

:..

SEMESTER: ...................................

KEPUTUSAN PEPERIKSAAN (HPNM)


Sem 1: .. Sem 2: .. Sem 3: .. Sem 4: . Sem 5: .. Sem 6: .......... ..

PENGLIBATAN KELAB/ PERSATUAN/ SUKAN DI POLITEKNIK


(Tuliskan persatuan/kelab yg utama jika melebihi 2 kelab/persatuan)
(KELAB / PERSATUAN)

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JAWATAN

:.TAHUN : ..

(SUKAN)

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PENCAPAIAN/ PENGLIBATAN: TAHUN : .


PENGALAMAN (Sila tandakan ( / ) kali ke berapa anda pernah menjadi fasilitator)
Kali Pertama:Ke-2:Ke-3:Ke-4: ..Ke-5:Ke-6:.
SAYA BERMINAT UNTUK MENJADI FASILITATOR KERANA (Tidak lebih dari 50 patah perkataan):
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Tanda Tangan,
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Tarikh: ..

*Sila serahkan borang ini ke Unit Psikologi & Kerjaya


-Semoga Berjaya-

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