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Examination and Graduation Section, Academic Management Division, Registry
1. INSTRUCTION FOR CANDIDATE
APPLICATION FORM FOR APPEAL AGAINST COURSE RESULT
1.1 Articles 2 to 4 in this form must be properly and completely filled in.
1.2 Payment must be made, which is RM25.00 for each examination paper reviewed at Bursary,
USM.
Main Campus
Revenue and Student Finance Section, Bursary, Ground Level,
H23 Building, Cahaya Siswa Complex .
USM Engineering Campus: Student Finance Section, Bursary.
Health Campus
Bursary, Health Campus,
OR through Money Order/Postal Order in the name of BENDAHARI USM . Cheques will be
not accepted.
1.3 The application must be sent to :
[a] Principal Assistant Registrar, Examination and Graduation Section, Academic Management
Division, Registry, Universiti Sains Malaysia, 11800 USM, PULAU PINANG
[For all students of Main and Health Campuses).
[b] Deputy Registrar, Reg istry, USM Engineering Campus, Seri Ampangan, 14300 Nibong
Tebal, SEBERANG PERAI SELATAN.
[For all students of USM Engineering Campus].
2. DETAILS OF CANDIDATE
2.1 Full Name
2.2 Passport Number
2.3 INDEX NUMBER
2.4 Address
2.5 Programme & Year of Study
2.6 Handphone Number
2.7 Coursers] to be reviewed
No. Course Code &Title Grade Semester
3. PAYMENT
3.1 Amount of Payment RM ________
[Please enclose a COPY of payment receipt together with this form].
3.2 Money Order/Postal Order Number
4. SIGNATURE : DATE :
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RH / fay.C : Borang Penyemakan Keputusan Peperiksaan . July 2013