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BHEA.BP.01.

07-00

KOLEJ POLY-TECH MARA IPOH


NO.154295 WISMA SSI
JALAN SULTAN ABDUL JALIL
GREENTOWN, 30450 IPOH
Tel : 05- 2421003
Fax : 05 - 2421001

STUDENT MONITORING REPORT

This form needs to be completed by the Academic Supervisor

Student’s Name :___________________________________________


I.D. No :___________________________________________
Organisation Name :___________________________________________
Industrial Supervisor Name :___________________________________________
Designation :___________________________________________
Contact No. :___________________________________________

Task Assigned :___________________________________________


___________________________________________

Comment :___________________________________________
___________________________________________
___________________________________________

Academic Supervisor Name :__________________________________________

Signature :__________________________________________

The completed form must be submitted to the Industrial Training Coordinator

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