Matric Number : CGS ______________

NOMINATION OF SUPERVISOR/SUPERVISORY COMMITTEE

PGR01

PART A TO BE COMPLETED BY STUDENT

Name : _____________________________________________________________

Programme : _____________________________________________________________

Learning Centre : _____________________________________________________________

IC/Passport Number : ____________________________ Matric Number : CGS ______________

Intake : ____________________________

Nomination for Semester : JAN MAY SEP Year ____________

Postal Address : ____________________________________________________________

____________________________________________________________

Telephone No. : ______________ Handphone No. : ________________

Email : ____________________________________________________________

Title of Research (use BLOCK LETTERS and refer to the Academic Guideline):

Attach a 3 – 5 page synopsis of the research proposal

I declare that the nominated supervisor(s) is NOT in any way closely related to me.
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Matric Number : CGS ______________

Signature of Student

Date

PART B TO BE COMPLETED BY SUPERVISOR

(Not required for MBA, MHRM, MM & MCC)

DETAILS OF SUPERVISOR

Name of Supervisor*:

Specialisation :

Institution & Address:

Telephone : (O) _______________________________ (H/P) ___________________________________

E-mail: ________________________________________________________________________________

Signature of Supervisor

Date :

* For first time Supervisor, please attach CV.

* Forms must be signed properly (typed only signature not accepted)

PART C FOR OFFICE USE ONLY

FOR PROGRAMME DIRECTOR/COORDINATOR ONLY FOR RPMU ONLY

Approved / Not approved i-Campus Updated

Endorsed by,

_____________________________
(Signature & Stamp) (Signed & Stamp)

Date : _____________________________ Date: __________________________

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Matric Number : CGS ______________

Remarks (if any):