UNIVERSITI PENDIDIKAN SULTAN IDRS

INSTITUT PENGAJIAN SISWAZAH

BORANG CADANGAN PERTUKARAN PENYELIA

EXCHANGE SUPERVISOR SUGGESTION FORM

Maklumat Pelajar/Student’s Detail

Nama/Name
No. Matrik/Matric No.
Fakulti/Faculty
Program/Programme
Semester/Semester
Mod Program/Programme Mode
Mod B/Mode B Mod C/Mode C Doktor Falsafah/Doctor of Philosophy
Sila tandakan () yang berkaitan / Please tick() where appropriate

Tajuk Proposal/Proposal Topic

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Ulasan Pertukaran/Reason for Exchange

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Penyelia Asal/Current Supervisor

Penyelia Utama/First Supervisor : ___________________________________________________________

Penyelia Bersama/Second Supervisor : ___________________________________________________________

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Cadangan Pertukaran Penyelia/Suggestion Exchange Supervisor

Penyelia Utama/First Supervisor : ___________________________________________________________

Penyelia Bersama/Second Supervisor : ___________________________________________________________

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UNTUK DIISI OLEH PENYELIA UTAMA /TO BE FILLED BY THE SUPERVISOR

Nama Penyelia/Supervisor’s Name : ____________________________________________________________

Fakulti/Faculty : ____________________________________________________________________________

Persetujuan/Recommendation : Ya/Yes Tidak/No

Ulasan/Comment

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Tandatangan dan Cop Rasmi Pegawai Tarikh/Date
Signature and Official Stamp of the Officer

UNTUK DIISI OLEH DEKAN / TIMBALAN DEKAN

TO BE FILLED BY THE DEAN / DEPUTY DEAN

Persetujuan/Recommendation : Ya/Yes Tidak/No

Ulasan/Comment

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Tandatangan dan Cop Rasmi Pegawai Tarikh/Date
Signature and Official Stamp of the Officer

UNTUK KEGUNAAN IPS / IPS USE ONLY

Diterima oleh/Accepted by : ____________________________________________________________________

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Tandatangan dan Cop Rasmi Pegawai Tarikh/Date
Signature and Official Stamp of the Officer