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UNISEL-BC00-F001

INDUSTRIAL TRAINING PROGRAMME


STUDENT PERSONAL DETAILS
PART A: STUDENT INFORMATION

NAME:
MATRIC NO: NRIC/PASSPORT:
DATE OF BIRTH: PLACE OF BIRTH:
FACULTY:
PROGRAMME:
MAJORING FIELD: *if any
LATEST CGPA: TOTAL CREDIT HOUR:
DURATION OF INDUSTRIAL TRAINING: to:
INDUSTRIAL TRAINING SEMESTER:
EMAIL :

CORRESPONDENCE
ADDRESS:

PHONE NO: (HOUSE): - (MOBILE):

________________________________________________________________________________________________
Centre for Business, Research, Industrial Linkages & Consultancy (BRIC)
Universiti Selangor, Ground Floor, Block Z, Jalan Zirkon A7/A, Seksyen 7
40000 Shah Alam, Selangor Darul Ehsan.
T: 03-5522 3511
E: bric@unisel.edu.my

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