PPS/A/R/E-001_2018-01

PUSAT PENGAJIAN SISWAZAH

UNIVERSITI TUN HUSSEIN ONN MALAYSIA

BORANG PENCALONAN PANEL PEMERIKSA

NOMINATION OF EXAMINER

ARAHAN : INSTRUCTIONS:
BAHAGIAN A – DILENGKAPKAN OLEH PELAJAR PART A – TO BE COMPLETED BY STUDENTS
BAHAGIAN B – DILENGKAPKAN OLEH PENYELIA UTAMA PART B – TO BE COMPLETED BY MAIN SUPERVISOR
BAHAGIAN C – PERAKUAN JAWATANKUASA PENG AJIAN SISWAZAH FAKULTI PART C – FACULTY’S G RADUATE STUDIES COMMITTEE RECOMMENDATION
BAHAGIAN D – PERAKUAN JAWATANKUASA AKADEM IK PENGAJIAN SISWAZAH PART D – ACADEMIC G RADUATE STUDIES COMMITTEE RECOMMENDATION
BAHAGIAN E – KEGUNAAN PENGAJIAN SISWAZAH PART E – CENTRE FOR GRADUATE STUDIES

BAHAGIAN A (PART A)
MAKLUMAT PELAJAR (STUDENT’S PARTICULAR)
DILENGKAPKAN OLEH PELAJAR (TO BE COMPLETED BY STUDENT)
1. Nama Pelajar (HURUF BESAR)
Name of Student (BLOCK LETTER)

2. No. Pelajar
Student No:

3. Fakulti
Faculty

4. Jabatan
Department

5. Kod Program Pengajian

Programme Code

6. Tajuk Tesis (Sertakan Abstrak sebagai lampiran)

Title of thesis (Enclose Abstract as attachment)

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Tandatangan Tarikh
Signature Date

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 PPS/A/R/E-001_2018-01
SULIT

BAHAGIAN B/PART B
MAKLUMAT PEMERIKSA (EXAMINER’S PARTICULAR)
DILENGKAPKAN OLEH PENYELIA UTAMA (TO BE COMPLETED BY MAIN SUPERVISOR)
1. Nama Penyelia Utam a
Name of M ain Supervisor

2. Fakulti
Faculty

3. Jabatan
Department

4. *Sila calonkan sekurang-kurangnya DUA nama Pemeriksa Dalam dan DUA nama Pemeriksa Luar untuk tindakan selanjutnya.
Sila lampirkan biodata (CV) calon.

Please nominate at least TWO candidates to sit as the Internal Examiner and TWO candidates for External Examiners.
Enclosed the biodata (CV) for each candidate.

(a) Calon Pemeriksa Dalam

Candidates for the Internal Examiner

Bil Nam a Jawatan Fakulti

No Name Designation Faculty
(i)

(ii)

(b) **Calon Pemeriksa Luar

Candidates for the External Examiner

Bil Nam a Jawatan Alamat Institusi

No Name Designation Address of Institution
(i)

(ii)

(iii)

5. Sila berikan justifikasi pemilihan untuk menyokong pencalonan.

Please provide justification to support the nomination.

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Tandatangan Tarikh
Signature Date

Nota
Note
1) Sila kemukakan borang ini kepada Jaw atankuasa Pengajian Siswazah Fakulti
Please submit this form to the Faculty ’s G raduate Studies Committee.
2) * Pemeriksa m estilah Staf Sisw azah dan pakar dalam bidang berkaitan.
* Examiner(s) must be a graduate staff and expert in the relevant areas..
3) Sila susun calon mengikut keutamaan.
Please nominate the candidates according to the priority.
4) Beri justifikasi yang kukuh tetapi ringkas untuk m enyokong calon.
P rovide strong justification to support the nomination.

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SULIT PS.04/03/201 3a

BAHAGIAN C/PART C
SOKONGAN JAWATANKUASA PENGAJIAN SISWAZAH FAKULTI
FACULTY’S GRADUATE STUDIES COMMITTEE RECOMMENDATION
1. Tarikh Mesyuarat Jawatankuasa
Date of Committee Meeting

Keputusan Mesyuarat :
Meeting Decision
(i) Pemeriksa Dalam
Internal Examiner

(ii) Pemeriksa Luar-I

External Examiner-I

(iii) Pem eriksa Luar-II

External Examiner-II

2. Sokongan Jawatankuasa Pengajian Siswazah Fakulti

Recommendation of Faculty's Graduate Studies Committee's

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Tandatangan Tarikh
Pengerusi Jawatankuasa Pengajian Siswazah Fakulti Date
Signature of the Chairm an of Faculty’s Graduate Studies Committee

Nama
Name ……………………………………………………………………….

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SULIT PS.04/03/2013a

BAHAGIAN D /PART D

PERAKUAN JAWATANKUASA AKADEMIK PENGAJIAN SISWAZAH

APPROVAL BY GRADUATE STUDIES ACADEMIC COMMITTEE

Tarikh Terima: Rujukan:

Receipt Date: Reference:

No Perkara / Item Tarikh / Date Keputusan / Decision Catatan / Remark

1. Mesyuarat Jawatankuasa Akademik Pengajian Diluluskan /

Siswazah dan Status Keputusan Appro ved

Graduate Studies Academic Committee Tidak Diluluskan

Meeting and decision / Not Approved

Perakuan / Approval Nama / Name Tandatangan / Signature

Dekan Pusat Pengajian Siswazah

Dean of Centre for Graduate
Studies

W akil Fakulti
Faculty’s Representative

Ahli Jawatankuasa Akademik

Pengajian Siswazah
Member of Graduate Studies
Academic Committee

PERAKUAN JKPS/APPROVAL BY JKPS : ………………………………………………

KELUL USAN SENAT/APPROVAL BY SENATE: …………………………………………..

PINDAAN (JIKA ADA)/AMENDMENT (IF ANY) : Pem eriksa Dalam / Internal E xaminer : ………………………………………………

Pem eriksa Luar / E xternal Examiner : …………………………………….…………

BAHAGIAN E/PART E
KEGUNAAN PUSAT PENGAJIAN SISWAZAH
CENTRE FOR GRADUATE STUDIES USE ONLY
Lantikan Tarikh Keluar Status Penghantaran Status Tarikh Viva Catatan
Appointment Surat Date of Penerimaan Tesis Penerimaan Viva Date Remarks
issued letter Acceptance Thesis Delivery Acceptance
Status Status
Pemeriksa Dalam
Internal Examiner
Pemeriksa Luar
External Examiner
Pengerusi
Chairperson

* Tandakan ( ) pada petak yang berkenaan / Please ( ) in relevant box

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 CENTRE FOR GRADUATE STUDIES
UNIVERSITI TUN HUSSEIN ONN MALAYSIA

EXTERNAL EXAMINERS : CONTACT DETAILS (LATEST)

External Examiner 1 External Examiner 2

Name : Title: First Name : Last Name: Title: First Name : Last Name:

Position :
Correspondence Address :

Office Number :
H/P Number :
Fax Number :
Email :

Note : The Supervisor is responsible for the accuracy of information provided above.

Supervisor's signature : ……………………………………… Date :………………………………………………….

Official stamp :