Date:

Time: 8.00am to 5.00pm

Topic/Activity/Issue/Problem:

Objective/Goal/Purpose:

Finding/Solution/Conclusion:

Others:

Verified by:
Industrial Training Plan

Period Tasks / Activities

Student Information
Full Name : ______
Matrix No : IC No. :
Program :
Contact No. : E-Mail :
Permanent Address :

______
Next of kin (relationship): _ Phone / HP : ______
Current Address:

_______
In case of emergency, please contact : _______
Company Information
Company : ______
Supervisor : ______
Post : ____ Phone/ HP : ______
Company Address :

Period of Industrial Training : until

Faculty Contact Detail

Faculty Level Chief Industrial
Training Coordinator :
Contact Number :

Program Level Industrial

Training Coordinator :
Program :
Contact Number :