‫ال‬

‫م‬
‫س‬
‫تو‬
AMMAN - JORDAN ‫ى‬
‫الذهبي‬
‫جامعة كل العرب‬
FORM ET-1
ENGINEERING TRAINING APPLICATION FORM
Part 1: Student Information
Name: ESSAM EDDIN AHMED ESSAM EDDIN ABU ASAB
ID#: 201810624
Major: GPA: Number of completed credit hours:
Industrial Engineering Good 160 Hours
Start Date: End Date:
23/7/2023 24/9/2023
Mailing Address while in Training:
Saudi Arabia - Khamis Mushait
Personal Phone: 00962789374140 Email: essamaaaab@gmail.com
Emergency Contact Name: Relation to you: Contact phone:
Essam Abu Asab Me 00962777799621

Part 2: Employer Information

Employer (Company) Name: Industrial Orthopedic Company (IOC)
Training Supervisor Name: Puneet Parmar
Training Supervisor Title: Operations Manager
Training Supervisor phone: 00966537030170
Training Supervisor Email: puneetparmar.ioc@gmail.com
Company Address:
Saudi Arabia – Khamis Mushait – Moddon Assir Industrial City

Part 3: Training Advisor Acknowledgement

By signing, I acknowledge that I have met with the above-named student and discussed how this
training relates to his/her academic program.
Training Advisor Name: Puneet Parmar

Training Advisor Signature and Date:

Student Signature and Date:

Meets Requirements Petition Dean’s Signature:

Tel :5609999 _ Fax: 5232899 _ Amman – Jordan

Form code: UF 122/1 Resolution number 24/233 Accreditation date: 31/01/2018