UKM/PPPS/B/P02/AK04/5

Tarikh Kuat kuasa: 03-03-2011

BAHAGIAN PENGURUSAN AKADEMIK

UNIVERSITI KEBANGSAAN MALAYSIA
BORANG PERMOHONAN PERTUKARAN PROGRAM/ CHANGE OF PROGRAMME APPLICATION FORM
(SEMESTER / SEMESTER ______ / SESI / SESSION___________________)

A. 1

NAMA / NAME : _____________________________________________________________

NO. MATRIK/ MATRIC NO : _______________________________________________

Maklumat Pemohon / Application details :

a)

Kelayakan masuk/Admission qualification : __________________________________________________________________________

b)

Alamat semester/ Semester address : ______________________________________________________________________________

c)

Keputusan peperiksaan terakhir / Latest final examination result (CGPA) : _________________________________________________

d)

Biasiswa / Scholarship : Persendirian/lain-lain/ Self-financed/ others : _____________________________________________________

e)

Telefon : _____________________________

PROGRAM SEKARANG
CURRENT PROGRAMME

PROGRAM BAHARU YANG DIPOHON

NEW APPLICATION PROGRAMME

Program/ Programme : _______________________________

Program/ Programme : _______________________________

Fakulti/ Faculty : ___________________________________

Fakulti/ Faculty : ___________________________________

Tandatangan pelajar : _______________________________

Students signature

Tarikh/ Date: _______________________________________

Sebab-sebab memohon bertukar program / Reasons for applying for change of programme :

____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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(Gunakan lampiran jika ruang tidak mencukupi)/ Use attachment if the space is insufficient

KEGUNAAN FAKULTI/ FOR FACULTY USE

B. Ulasan Dekan Fakulti / Deans Comment
(Program asal/ Original Programme)

Ulasan Dekan Fakulti / Deans Comment

(Program yang dipohon/ Programme Applied)

Permohonan disokong / tidak sokong

Application is supported/not supported

Permohonan diterima / ditolak

Application is approved/not approved

______________________________________
______________________________________
______________________________________

______________________________________
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Tandatangan & Cop Dekan : ______________________

Signature of Dean

Tandatangan & Cop Dekan : ______________________

Signature of Dean

Tarikh/ Date :

______________________

Tarikh/ Date :

______________________

KEGUNAAN BAHAGIAN PENGURUSAN AKADEMIK/ FOR USE OF ACADEMIC DIVISION

C. TINDAKAN : Memenuhi Syarat Kemasukan Ke Program Baru
: Kemaskini SMP
: Surat Tawaran
: Pengesahan Akademik
Tandatangan
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