PK.FKK.PPLI.

TAWARAN (1)

INDUSTRIAL TRAINING PLACEMENT FORM

Reference No. : ...............................................................
Date : ...............................................................

…………………………………………………….
Industrial Training Coordinator Fax: 03-5543 6300
Faculty of Chemical Engineering
fkk.eh220@gmail.com
Universiti Teknologi MARA
fkk.eh223@gmail.com
40450 Shah Alam, Selangor Darul Ehsan

We hereby AGREE / DISAGREE* to accept your student to undergo the industrial training in our company
within the period of __________________ until _______________. The particulars of the arrangement are as
follows:

Student’s name : ............................................................................................

Program : EH220 EH243

Company name : ............................................................................................

Company address : ............................................................................................

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

Supervisor’s name : ............................................................................................

Department : ............................................................................................

Monthly allowance (if any) : ............................................................................................

**
Offer valid until : ............................................................................................

Please indicate the job roles/responsibilities of this trainee in your organization (compulsory to fill):
……………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………
Thank you.

Yours faithfully

Important Note: Student to fill in

……………………………………………… COORDINATOR AND STUDENT
(Signature) PARTICULARS ONLY. Tick the respective
Name: ........................................................................................ email address and program box before
attach this form in application.
Position: ....................................................................................

Contact no.: ..............................................................................

* Please cross the inapplicable
** Final date in which the student must send official notification to the company / organization confirming placement. In
the event that no notification is sent, the above offer automatically becomes null and void.

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