PUSAT PENGAJIAN

PENDIDIKAN JARAK JAUH

Universiti Sains Malaysia

COURSE CODE/TITLE:_______________________________
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EXPERIMENT NO:__________ DATE OF EXPERIMENT:_________________

TITLE OF EXPERIMENT: __________________________________________
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TUTOR/LECTURER:_______________________________________________
DATE OF SUBMISSION:___________________

NAME
MATRIC NO.
I.C NO.

REGIONAL
CENTRE
TELEPHONE HOUSE: H/P:
NO.
EXPERIMENT 1.
PARTNER(S)
2.
3.

ATTENTION
1. ALL LAB REPORTS MUST USE THIS FORM AS THE COVER PAGE.
2. COMPLETE ALL DETAILS.