Faculty of Engineering

Application Form to Read Evening Modules(s) During Industrial Attachment

<For Students on EG3601 Only>
The total number of evening modules you can read must not exceed two.
Please follow through these steps for the application procedure:
1.
2.
3.

Complete section A of the form and clearly indicate the evening modules you will read.
Obtain approval from your host supervisor(s). (Section B)
Submit the form to your home department for approval. (Section C)

B.Tech modules will be allocated to you by your home Department; if the application is successful. Outcome of
application for B.Tech modules will be notified by your home department.
Please submit the form before Week 2 of the regular semester. If you are found reading module(s) in addition
to EG3601 Industrial Attachment Programme without submitting the application form, the module(s) will be
dropped.
Section A (To Be Completed By Students)
Name of Student:
Matric Number :
Department :
Internship Period :
Module Information
How many evening module(s) are you applying for?

One Two

Module One

Module Two

Module Title:

Module Title:

Module Code:

Module Code:

Modular Credits:

Modular Credits:

Lecture Days :
(eg. Mon,Tue)

Lecture Days :
(eg. Mon,Tue)

Lecture Timing :
(eg. 6pm 9pm)

Lecture Timing :
(eg. 6pm 9pm)

Signature of Student:

Date :

(Please tick one only)

Section B (To Be Completed By Host Company)

Company Name :
Name of Approver :
Designation :
Contact No. :
Email Address :

We are agreeable to allow the above student to take time-off from work to read the evening
module(s).
Signature of Approver :

Date :

Faculty of Engineering

Section C (To Be Completed By Home Department)

Name of Dept Administrator : ____________________________
Department : ______________________________________________

The module information in the application is verified and the application is

approved / not approved.
B.Tech course registration will be made on behalf of the student.

Signature of Administrator :

Date :

Remarks (If any)