PUSAT PERKEMBANGAN ILMU DAN PENGAJIAN PROFESIONAL

CENTRE FOR ENHANCEMENT OF KNOWLEDGE AND PROFESSIONAL STUDIES

BORANG CADANGAN KAJIAN DAN PENYELIAAN-MOD KERJA KURSUS,
MOD PENYELIDIKAN DAN KERJA KURSUS & DOKTOR PENDIDIKAN
PROPOSED RESEARCH AND SUPERVISOR FORM-COURSE WORK MODE, MIXED MODE & DOCTOR OF EDUCATION
Lengkapkan borang (bahagian A – C) sebelum dihantar ke Pej. Am Fakulti dan selewat – lewatnya dua(2) bulan dari tarikh pendaftaran
Disertasi.
Fill up the form (part A- C) before submitting to the Faculty and at least two (2) months before registration date

A . BUTIR-BUTIR PERIBADI / PERSONAL DETAILS

Nama/Name : ______________________________________________________________________________________

No. Matrik/Matric’s No. :______________________________ Semester: ____________________________

Alamat Surat – Menyurat / Corresponding Address : _______________________________________________________

_________________________________________________________________________________________________

No. Telefon/Phone No: _______________________ E-mel/E-mail : __________________________________

B. BUTIR-BUTIR AKADEMIK / ACADEMIC DETAILS

Bidang/Field: ___________________________________________

Bilangan Kursus Yang Telah Diambil/ No. of Courses Taken : _____________ PNGK/CGPA : _______________

Cadangan Tajuk Kajian /Proposed Research Title:

________________________________________________________________________________________________
________________________________________________________________________________________________
Cadangan Penyelia ( sekurang-kurangnya satu orang) /Proposed Supervisor (at least one name)

1. __________________________________________________________________________________
2. __________________________________________________________________________________

C. PERAKUAN / DECLARATION
Dengan ini saya mengaku mematuhi peraturan program pengajian yang telah ditetapkan oleh Universiti. / With this, I
declare that all rules and regulations stated by the University are followed.

___________________________ _________________
Tandatangan Pelajar / Student’s Signature Tarikh/Date

D. CADANGAN FAKULTI / FACULTY’S RECOMENDATION

Nama Penyelia : _____________________________________________________

Supervisor’s Name
_____________________________________________________

__________________________________________ ________________
Tandatangan Dekan/Timbalan Dekan & Cop Rasmi Tarikh
Signature & Official Stamp of the Dean/Deputy Dean Date