PERMOHONAN PELANJUTAN

(APPLICATION FOR EXTENSION)

Sesi..Semester.
(Session) (Semester)

Sila tandakan ():

Please tick ():

Skim Biasiswazah (SB) Skim Biasiswa Universiti Malaya (SBUM)

Fellowship Scheme University of Malaya Fellowship Scheme
Sasakawa Young Leaders
Fellowship Fund (SLYFF)

BAHAGIAN I (UNTUK DILENGKAPKAN OLEH CALON)

Part I (To Be Completed by the Candidate)

A. Butir- Butir Calon

(Details of Candidate)

Nama Calon : ......................................................................................................................

(Name of Candidate)

Akademi/Institut/Fakulti/Pusat: ..........................................................................................
(Academy/Institute/Faculty/Centre)

Nombor Pendaftaran: Sarjana

(Registration Number)
PhD

Tarikh Mula Memegang Skim:

(Date of Commencement of Scheme)

a) Pelanjutan Pertama: .. hingga

(First extension)

b) Pelanjutan Kedua: . hingga .

(Second extension)

c) Pelanjutan Ketiga: .... hingga ..

(Third extension)

d) Pelanjutan Keempat: .hingga..

(Fourth extension)

B. Kursus (Courses)

1. Nama Penyelia/Penasihat Program:

(Name of Supervisor/Programme Advisor)

2. Kursus - kursus pengajian yang perlu diambil:

(Courses to be taken)

1
 Kod Kursus Tajuk Kursus Semester/Sesi
(Course Code) (Course Title) (Semester/Session)

2. Peperiksaan yang akan diambil:

(Examinations to be taken)

Kod Kursus Tajuk Kursus Semester/Sesi

(Course Code) (Course Title) (Semester/Session)

4 Peperiksaan yang telah diambil

(Examinations taken)

Kod Tajuk Kursus Tarikh Gred Tarikh Gred

Kursus (Course Title) Peperiksaan (Grade) Peperiksaan (Grade)
(Course (Date of Tambahan
Code) Examination) (Date of
Supplementary
Examination)

Sila sertakan salinan slip keputusan peperiksaan (Please attach your examination result slip)

C. Laporan Kemajuan Penyelidikan Oleh Calon

(Research Progress Report By Candidate)

Bidang Penyelidikan : .........................................................................................................

(Field of Research)

Tajuk Penyelidikan (Jika Ada): ..........................................................................................

(Research Title, If Available)

Nama Penyelia Pertama: .................................................................................................

(Name of First Supervisor)

Nama Penyelia Kedua/Bersama*: ...................................................................................

(Name of Second/Co-Supervisor*)
*Batalkan yang mana tidak berkenaan (Delete where necessary)

2
 Perkara Laporan Calon
(Item) (Candidates Report)
Mengumpul Kesusasteraan
(Literature Review)

Rekabentuk dan Pembangunan Projek

(Design and Development of Project)

Mengumpul dan Menganalisa Data

(Data Collection and Analysis)

Sertakan lampiran jika ruang tidak mencukupi (Attach a separate sheet if space is insufficient)

Penulisan Tesis/Disertasi (Thesis/Dissertation Writing)

Bilangan Bab yang Dicadangkan : .....................................................................................

(Number of Proposed Chapters)

Kemajuan Penulisan Laporan Calon

(Writing Progress) (Candidates Report)

Bilangan Bab Yang Siap

(Number of Chapters Completed)

Bilangan Bab Yang Diserah Kepada Penyelia

(Number of Chapters Submitted To Supervisor)

Bilangan Bab Yang Belum Siap Ditulis

(Number of Incomplete Chapters)

Sertakan lampiran jika ruang tidak mencukupi (Attach a separate sheet if space is insufficient)

Tarikh Jangkaan Tesis/Disertasi Diserahkan :

(Expected Date of Thesis/Dissertation Submission)

Masalah Dihadapi : ...............

(Problems Encountered)
...............

D.Sumbangan Akademik
(Academic Contributions)

i. Pembentangan Kertas Penyelidikan/Penyertaan dalam Seminar atau Bengkel

(Paper presentations/Seminars or Workshop attended)

Ya/Yes Tidak/No

Jika Ya, sila berikan butiran lanjut dan sertakan bukti

(If Yes, please provide details and attach evidence)

3
ii. Penerbitan
(Publication)

Ya/Yes Tidak/No

Jika Ya, sila berikan butiran lanjut dan sertakan bukti

(If Yes, please provide details and attach evidence)

iii. Membantu dalam tutorial/amali/kerja lapangan

(Assist in tutorials/practicals/field work)

Ya/Yes Tidak/No

Jika Ya, sila sertakan butiran lanjut contoh seperti bilangan jam, nama kursus
(If Yes, please provide details e.g. no. of hours, name of course)

Pengakuan Pemohon:
(Applicants Declaration)

Saya mengaku bahawa keterangan yang diberikan di atas adalah tepat dan benar. Saya akui bahawa
pihak Universiti Malaya berhak untuk menolak permohonan ini tanpa perlu memberi alasan, atau menarik
kembali pemegangan Skim sekiranya didapati mana-mana keterangan yang saya berikan tidak benar.
(I declare that all information given in this application is accurate and true. I agree that the University of Malaya reserves the right to
reject this application without giving any reasons or to withdraw the offer at any time if any information given is found to be untrue.)

Tarikh : . Tandatangan Calon :

(Date) (Candidates Signature)

4
 Bahagian II Laporan Penyelia Pertama/Penyelia Kedua/Bersama*
Part II (First Supervisor/Second/Co-Supervisors Report)

Penilaian Terhadap Calon

(Students Rating)

Sila Gunakan Skala Berikut :

(Please Use the Following Scale)

1 2 3 4 5

Lemah Sederhana Baik Sangat Baik Cemerlang

(Poor) (Fair) (Good) (Very Good) (Excellent)

Penyelia Penyelia Penyelia Penyelia

Pertama Kedua/Bersama* Pertama Kedua/Bersama*
(First (Second/Co- (First (Second/Co-
Supervisor Supervisor) Supervisor) Supervisor)

(a) Ketekunan (e) Kecekapan Bahasa

(Commitment) Tesis/Disertasi
(Thesis/Dissertation
Language Proficiency)

(b) Kehadiran (f) Kebolehan Bekerja

(Attendance) Sendiri
(Ability To Work
Independently)

(c) Minat (g) Prestasi Keseluruhan

(Interest) (Overall Performance)

(d) Mutu Kerja dan

Kecekapan
(Work Quality
and Efficiency)

*Batalkan yang mana tidak berkenaan (Delete where necessary)

5
 Kemajuan Penyelidikan (Research Progress)

Perkara Laporan Penyelia Pertama Laporan Penyelia Kedua/Bersama*

(Item) (First Supervisors Report ) (Second/Co-Supervisors Report )

Mengumpul Kesusasteraan
(Literature Review)
Rekabentuk dan
Pembangunan Projek
(Design and Project Development)
Mengumpul dan
Menganalisa Data
(Data Collection and Analysis)
Status Penulisan
Tesis/Disertasi
(Status of Thesis/Dissertation
Writing)
Sertakan lampiran jika ruang tidak mencukupi (Attach a separate sheet if space is insufficient)
*Batalkan yang mana tidak berkenaan (Delete where necessary)

Ulasan Penyelia Pertama mengenai permohonan pelanjutan Skim Biasiswa Universiti Malaya.
(Comment of First Supervisor concerning the application for extension of University of Malaya Fellowship Scheme)

.............................................................................................................................................

.............................................................................................................................................

Ulasan Penyelia Kedua/Bersama mengenai permohonan pelanjutan Skim Biasiswa Universiti Malaya
(Comment of Second/Co-Supervisor concerning the application for extension of University of Malaya Fellowship Scheme)

.............................................................................................................................................

.............................................................................................................................................

Penyelia Pertama Penyelia Kedua/Bersama*

(First Supervisor) (Second/Co-Supervisor)

Memuaskan
(Satisfactory)
Kemajuan Calon :
(Candidates
Progress)
Sederhana
(Moderate)

Tidak Memuaskan
(Unsatisfactory)

.
Tarikh Tandatangan Penyelia Pertama Tarikh Tandatangan Penyelia Kedua/Bersama*
(Date) (First Supervisors Signature) (Date) (Second/Co-Supervisors Signature)

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Bahagian III Perakuan Ketua Jabatan
Part III (Head of Department/Programme/Projects Recommendation)

Disokong /Tidak Disokong * Pelanjutan Skim Biasiswa Universiti Malaya

(Support/Do Not Support * Extension of University of Malaya Fellowship Scheme)

Tarikh Tandatangan Ketua Jabatan
(Date) (Head of Department/Programme/Projects Signature)

Bahagian IV Perakuan Pengarah/Dekan

Part IV (Director/Deans Recommendation)

Disokong/Tidak Disokong * Pelanjutan Skim Biasiswa Universiti Malaya

(Support/Do Not Support * Extension of University of Malaya Fellowship Scheme)

Tarikh Tandatangan Pengarah/Dekan
(Date) (Director/Deans Signature)

*Batalkan yang mana tidak berkenaan (Delete where necessary)

Bahagian V (Untuk dilengkapkan oleh Dekan, Institut Pengajian Siswazah)

Part V (To Be Completed by Dean, Institute of Graduate Studies)

Permohonan Diluluskan Untuk Semester: .. Sesi: ..

(Application Approved for Semester Session)

Permohonan Tidak Diluluskan

(Application Rejected)

Tandatangan : Date:
(Signature) (Date)

Nama : .
(Name)

Cop : .
(Stamp)

MHJ/nha: Extension(May2015)