Matric Number : CGS ______________

CHANGE OF SUPERVISOR/SUPERVISORY COMMITTEE

PGR02

PART A TO BE COMPLETED BY STUDENT

Name : _____________________________________________________________

Programme : _____________________________________________________________

Learning Centre : _____________________________________________________________

IC/Passport Number : ____________________________ Matric Number : CGS ______________

Intake : ____________________________ Current Semester : ________________

Postal Address : _____________________________________________________________

_____________________________________________________________

Telephone (Office) : ______________ Handphone : _______________________

Email : _____________________________________________________________

Title of Research/Project (use BLOCK LETTERS):

Current Supervisor(s) : 1) ___________________________________________________________

*2) ___________________________________________________________

*3) ___________________________________________________________

* If applicable

Supervisor(s) to be replaced: 1) ___________________________________________________________

*2) ___________________________________________________________

*3) ___________________________________________________________

* If applicable

1
Matric Number : CGS ______________

Reason for Change : _____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Signature of Student Date

PART B TO BE COMPLETED BY NEW SUPERVISOR(S)

DETAILS OF SUPERVISOR 1

Name of Supervisor*:

Specialisation : ______________

Institution & Address: _______

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

E-mail: ________________________________________________________________________________

Signature of Supervisor Date

DETAILS OF SUPERVISOR 2 (if necessary)

Name of Supervisor*:

Specialisation : ______________

Institution & Address: _______

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

E-mail: ________________________________________________________________________________

Signature of Supervisor Date

2
Matric Number : CGS ______________

DETAILS OF SUPERVISOR 3 (if necessary)

Name of Supervisor*:

Specialisation : ______________

Institution & Address: _______

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

E-mail: ________________________________________________________________________________

Signature of Supervisor Date

* For first time Supervisor(s), please attach CV. The supervisor(s) nominated should not be any
way related to the student

PART C FOR OFFICE USE

FOR PROGRAMME COORDINATOR ONLY FOR RPMU ONLY

I-Campus Updated
Approved / Not approved
Verified by,

__________________________________
(Signature & Stamp) (Signature & Stamp)

Date : _____________________________
Date : ________________________________

Remarks (if any):

3
Matric Number : CGS ______________