borang permohonan / application form - MyUM - Universiti Malaya
borang permohonan / application form - MyUM - Universiti Malaya
borang permohonan / application form - MyUM - Universiti Malaya
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
BORANG PERMOHONAN<br />
ANUGERAH & HADIAH UNIVERSITI MALAYA<br />
(APPLICATION FORM UNIVERSITY OF MALAYA AWARDS)<br />
1. Sila tanda √ pada kotak anugerah yang di pohon.<br />
(Please tick √ the box of the award you are applying)<br />
Gambar ukuran<br />
paspot<br />
Photo of pasport<br />
size<br />
Anugerah Pelajaran DiRaja<br />
(Royal Education Award)<br />
Hadiah Alumni University of <strong>Malaya</strong> (Singapore)<br />
(Alumni Award University of <strong>Malaya</strong> (Singapore)<br />
Kedua-dua di atas<br />
(Both)<br />
2. Sila lampirkan salinan sijil dan lain-lain dokumen sokongan.<br />
(Please enclose a copy of certificate and other ssupporting documents)<br />
3. PERHATIAN : Calon yang disenarai pendek dikehendaki menghadiri temuduga.<br />
(ATTENTION : Shortlisted candidates will be required to attend an interview)<br />
SILA LENGKAP SEMUA SEKSYEN(PLEASE COMPLETE ALL SECTIONS)<br />
A. BUTIR PERIBADI/PERSONALDETAILS:<br />
Nama Name:_______________________________________________________________Tarikh Lahir Date of birth__________________<br />
No. K.P IC No/.(Passport No) :_______________________________ No. Pendaftaran Student No: ________________________________<br />
Program Pengajian Programme of Study: ______________________________________________________________________________<br />
Pengkhususan Majoring (Jika berkenaan if applicable):___________________________________________________________________<br />
No. Telefon Rumah Home Phone No: _______________________No. Telefon Bimbit:Mobile Phone No:____________________________<br />
E-mel Email:_________________________________________________________<br />
Alamat Kediaman Resident Address: ________________________________________________________________________________<br />
*Taraf Kerakyatan: Bumiputera Bukan Bumiputera *Jantina: Perempuan Lelaki<br />
Nationality status Non Bumiputera Gender: Female Male<br />
B. BUTIR IBUBAPA/PENJAGAPARENT/GUARDIAN DETAILS:<br />
BUTIR/Info BAPA/Father IBU/Mother *PENJAGA/Guardian<br />
Nama Name<br />
Kerakyatan Nationality<br />
Pekerjaan Occupation<br />
Pendapatan (sebulan)<br />
Income (Monthly)<br />
* HubunganRelation : ___________________________________________<br />
1
C. KEPUTUSAN PEPERIKSAAN KESELURUHAN/OVERALL EXAMINATION RESULTS:<br />
Sesi Akademik/<br />
Tahun Pengajian<br />
(Academic Session/<br />
Study Year)<br />
Semester<br />
I<br />
II<br />
Khas /Special<br />
I<br />
II<br />
Khas /Special<br />
I<br />
II<br />
Khas /Special<br />
PNGK CGPA<br />
Sesi Akademik /<br />
Tahun Pengajian<br />
(Academic Session/<br />
Study Year)<br />
Semester<br />
I<br />
II<br />
Khas /Special<br />
I<br />
II<br />
Khas /Special<br />
I<br />
II<br />
Khas /Special<br />
PNGK<br />
CGPA<br />
D. AKTIVITI KO-KURIKULUM/CO - CURRICULUM ACTIVITIES:<br />
NOTA: Sila senaraikan kegiatan ko-kurikulum yang disertai sejak mendaftar sebagai pelajar Ijazah Pertama <strong>Universiti</strong> <strong>Malaya</strong>.<br />
Lampirkan sijil atau lain-lain dokumen sokongan yang berkenaan. Sila guna lampiran tambahan sekiranya ruangan tidak<br />
mencukupi.<br />
NOTES: Please list down your co-curriculum activities since registered as undergraduate student of University of <strong>Malaya</strong>.<br />
Please attach your certificate or any other support document regarding the activities. Please use additional enclosure if<br />
columns provided is not sufficient.<br />
PERSATUAN /SOCIETIES<br />
Sesi Akademik/<br />
Tahun Pengajian<br />
(Academic<br />
Session/Study Year)<br />
NAMA PERSATUAN In<strong>form</strong>ation<br />
JAWATAN<br />
DISANDANG Position<br />
PERINGKAT Level**<br />
(sila tanda √)<br />
(Please tick √)<br />
A KN U FK<br />
CATATAN<br />
(kegunaan<br />
Jabatan)<br />
NOTES<br />
(office<br />
purposes)<br />
AKTIVITI SUKAN/SPORT<br />
Sesi<br />
Akademik/Academic<br />
Session<br />
Tahun Pengajian<br />
Study Year<br />
KETERANGAN In<strong>form</strong>ation<br />
JAWATAN<br />
DISANDANG Position<br />
PERINGKAT Level**<br />
(sila tanda √<br />
(Please tick √)<br />
A KN U FK<br />
CATATAN<br />
(kegunaan<br />
Jabatan)<br />
NOTES<br />
(Office<br />
Purposes)<br />
2
KESENIAN/CULTURAL ACTIVITY<br />
Sesi<br />
Akademik/Academic<br />
Session<br />
Tahun Pengajian<br />
Study Year<br />
KETERANGAN In<strong>form</strong>ation<br />
JAWATAN<br />
DISANDANG Position<br />
PERINGKAT Level**<br />
(sila tanda √<br />
(Please tick √)<br />
A KN U FK<br />
CATATAN<br />
(kegunaan<br />
Jabatan)<br />
NOTES<br />
(Office<br />
Purposes)<br />
AKTIVITI KEMASYARAKATAN/SUKARELAWAN/LUAR UNIVERSITI/COMMUNITY ACTIVITYOUTSIDE UNIVERSITY<br />
Sesi<br />
Akademik/AcademicSe<br />
ssion<br />
Tahun Pengajian Study<br />
Year<br />
KETERANGAN In<strong>form</strong>ation<br />
JAWATAN<br />
DISANDANG Position<br />
PERINGKAT Level**<br />
(sila tanda √)<br />
(Please tick √)<br />
A KN U FK<br />
CATATAN<br />
(kegunaan<br />
Jabatan)<br />
NOTES (Office<br />
Purposes)<br />
E. HADIAH-HADIAH YANG DIPEROLEHI Obtained Award/Prize:<br />
Sesi Akademik/<br />
Academic Session<br />
Tahun Pengajian<br />
Study Year<br />
ANUGERAH /HADIAH Award/Prize<br />
Hadiah kecemerlangan hasil dari pencapaian akademik dan kegiatan ko-kurikulum<br />
Award/Prize obtained from the result of excellent academic and extra co-curriculum activities<br />
PERINGKAT Level**<br />
Nama Hadiah/Anugerah Award/Prize Name<br />
(sila tanda √)<br />
(Please tick √)<br />
A KN U FK<br />
CATATAN<br />
(kegunaan<br />
Jabatan)<br />
NOTES<br />
(Office<br />
Purposes)<br />
**Petunjuk: A = Antarabangsa KN = Kebangsaan/Negeri U = <strong>Universiti</strong> FK = Fakulti/Kolej Kediaman<br />
Notes A = International KN = State/National U = University FK = Faculty/Resident College<br />
3
F. KELAKUAN PELAJAR:<br />
Saya mengakui bahawa, saya TIDAK PERNAH* PERNAH* dikenakan hukuman oleh Jawatankuasa Tatatertib<br />
Pelajar akibat dari tindakan kelakuan saya sebelum ini.<br />
I admit that I have never been* have been* convicted on any disciplinary offence under any disciplinary rules<br />
enforced in the Univeusity of <strong>Malaya</strong><br />
Saya mengakui bahawa segala maklumat yang diberi di atas adalah benar :<br />
I declare that all the in<strong>form</strong>ation given is correct :<br />
Tandatangan :_______________________________<br />
Signature<br />
Tarikh :_______________<br />
Date<br />
*Petunjuk: tanda “√” yang mana berkenaan<br />
Note: Please tick ‘√” where applicable<br />
4
Change language