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 (Structure I and II only).

I declare that the nominated supervisor(s) is NOT in any way closely related to me.

Signature of Student Date

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Matric Number : CGS ______________

PART B TO BE COMPLETED BY SUPERVISOR(S)

DETAILS OF SUPERVISOR 1

Name of Supervisor*:

Specialisation : ______________

Institution & Address: _______

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

E-mail: ________________________________________________________________________________

Signature of Supervisor Date

* For first time Supervisor(s), please attach CV.

PART C FOR OFFICE USE

FOR PROGRAMME DIRECTOR ONLY FOR RPMU ONLY

I-Campus Updated
Approved / Not approved
Endorsed by,

__________________________________
(Signature & Stamp) (Signature & Stamp)
Date : _____________________________
Date : ________________________________

Remarks (if any):

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