UNIT ALUMNI , BAHAGIAN HEA Universiti Teknologi MARA (UiTM) Cawangan Pahang (Kampus Jengka) 26400 Bandar Jengka, Pahang Darul Makmur

BORANG MAKLUMAT ALUMNI (GRADUAN) MAKLUMAT PERIBADI Nama Penuh : ______________________________________________ Jantina : Lelaki / Perempuan.* No. KP. Baru / Lama : ______________________________________________ Alamat Rumah / Pos : ______________________________________________ ______________________________________________ No. Tel. Rumah / Selular : ______________________________________________ E-mail : ______________________________________________ No. Faks : ______________________________________________ HomePage : ______________________________________________ Nama Bapa / Penjaga : ______________________________________________ Alamat Bapa / Penjaga : ______________________________________________ ______________________________________________ No. Tel. Bapa / Penjaga : ______________________________________________ MAKLUMAT AKADEMIK DI UiTM/ITM No. Pelajar : ______________________________________________ Kursus / Program : ______________________________________________ Sesi Masuk : ______________________________________________ Sesi Tamat : ______________________________________________ CGPA : ______________________________________________ Kampus Belajar : Jengka, Kuantan, Raub, _________________.* Status Pengajian : Sepenuh Masa, PLK (KLK), PJJ, e-PJJ (FLP). MAKLUMAT PENGAJIAN TERKINI Jenis Instituti : IPTA, IPTS, Luar Negara, ________________________* Kursus / Program : ______________________________________________ Alamat Institusi : ______________________________________________ ______________________________________________ No. Tel Institusi : ______________________________________________ E-mail : ______________________________________________ No. Faks : ______________________________________________ Website : ______________________________________________

No. Telefon : 09-4602221/2198/2012/2202 No. Faksimili : 09-4602207

URL Website : www.pahang.itm.edu.my

UNIT ALUMNI, BAHAGIAN HEA, Universiti Teknologi MARA (UiTM)

Cawangan Pahang (Kampus Jengka) 26400 Bandar Jengka, Pahang Darul Makmur

BORANG MAKLUMAT ALUMNI (GRADUAN) MAKLUMAT PEKERJAAN TERKINI Status Pekerjaan : Bekerja Sendiri, Kerajaan Swasta, Tidak Bekerja* Majikan : ______________________________________________ Alamat Majikan : ______________________________________________ ______________________________________________ Jawatan : ______________________________________________ Pendapatan / Gaji : ______________________________________________ No. Tel. Majikan : ______________________________________________ E-mail : ______________________________________________ No. Faks. : ______________________________________________ Website : ______________________________________________ MAKLUMAT PERSATUAN ALUMNI Nama persatuan : ______________________________________________ Tahun Ditubuhkan : ______________________________________________ Nama Presiden : ______________________________________________ Bilangan Ahli : ______________________________________________ No. Telefon / Faks. : ______________________________________________ Website : ______________________________________________ MAKLUMAT KEGIATAN Anugerah Diterima : ______________________________________________ Darjah Kebesaran : ______________________________________________ Keahlian Profesional : ______________________________________________ * Potong mana yang tidak berkenaan

No. Telefon : 09-4602221/2198/2012/2202 No. Faksimili : 09-4602207

URL Website : www.pahang.itm.edu.my