IGS FORM / RMP / 009 (Pin 2007)

RAYUAN MENERUSKAN PENGAJIAN

Institut Pengajian Siswazah

Arahan kepada pelajar: 1. Permohonan hendaklah disertakan resit bayaran RM50.00. Bayaran boleh dibuat secara tunai di kaunter Bendahari UiTM. 2. Permohonan yang lengkap hendaklah dimajukan kepada koordinator/ketua Program dalam tempoh 14 hari selepas tarikh rasmi

keputusan peperiksaan semester diumumkan. 3. Sila sertakan salinan Penyata Keputusan Peperiksaan akhir dan dokumen sokongan. 4. Permohonan yang lengkap perlu dibuat dalam 4 (empat) salinan.

Instructions to candidate: 1. Application must be submitted together with RM50.00 receipt of payment. Cash payment can be made at Bursary UiTM counter. 2. Completed form must be submit to Programme Coordinator within 14 days after official date of semester results release. 3. Ensure to enclosed the Final Examination Result Slip together with supported documents . 4. Completed form must be submitted in 4 copies.

BAHAGIAN I (Diisi oleh pelajar dengan menggunakan HURUF BESAR) SECTION I (To be filled by student in CAPITAL LETTERS)

Nama : Name

No. K.P Baru: I.C No/Passport No.

Kod Fakulti:Faculty Code

No. Kad Pelajar: Student ID No.

Kampus:Campus

Kod Program: Programme Code

Semester:Semester

Jantina:Gender

Lelaki Male

PerempuanFemale

Peringkat Pengajian: Level of Study

Sarjana Master

Kedoktoran PhD

Mod Pengajian: Mode of Study

Sepenuh Masa Full Time

Separuh Part Time

FLP FLP

Alamat Surat-Menyurat *( )

Mailing Address

*Jika ada perubahan alamat, sila tandakan ( ) * Please tick ( ) for change of address No. Tel: Tel.No

No. Tel. Bimbit:Mobile Phone

E-mel: E-mail

Tajaan (jika ada): Sponsorship /Funding .......................................................................................................................................................................................... BAHAGIAN II (Diisi oleh pelajar) SECTION II (To be filled up by students)

Status pemberhentian: Status of discontinue: D1 D3 D4 D5 D6 D7

(Sila tandakan ( ) pada kotak berkenaan)Please tick ( ) at relevant boxes

Sebab-sebab rayuan meneruskan pengajian dibuat: Reasons to appeal for continuation of study: ..............................................................................................................................................................................................................................

..............................................................................................................................................................................................................................

.............................................................................................................................................................................................................................. (Jika ruang tidak mencukupi, sila lampirkan penerangan tambahan) Please provide additional explaination in separate sheet if space not sufficient. Saya mengaku segala maklumat yang diberi di atas adalah benar.Hereby i confess, all information given is true.

Tandatangan Pelajar Students Signature

Tarikh Date

APPEAL FOR CONTINUATION OF STUDY Institute of Graduate Studies

Poskod: Postcode

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BAHAGIAN III (Pelajar dikehendaki mendapatkan pengesahan daripada pihak berkenaan) SECTION III (Student is required to get endorsement from the following parties)

A. BENDAHARI BURSAR Pengesahan dari Bendahat dan dapatkan slip bayaran Endorsement by Bursar and please get the payment slip

B. FAKULTI FACULTY Pengesahan Koordinator / Ketua Program Fakulti Endorsement by Programme Coordinator / Head of Programme

C. PEJABAT IPSis IGS OFFICE Keputusan Mesyuarat Lembaga Rayuan Meneruskan Pengajian (RMP), UiTM Appeal of Continuation of Study Board Meeting result

Permohonan diluluskan Application Approved Permohonan tidak diluluskan Application Not Approved

Disokong Support Tidak Disokong Do Not Support

Nama & Tandatangan: Name & Signature:

Cop Rasmi Official Stamp

Tarikh Date

Nama & Tandatangan: Name & Signature:

Cop Rasmi Official Stamp

Tarikh Date

Tandatangan Dekan b/p Pengerusi RMP: Deans Signature on behalf of RMPs Chairman:

Cop Rasmi Official Stamp

Tarikh Date

Institut Pengajian Siswazah (IPSis)Institute of Graduate Studies (IGS)

INTEKMA Convention Centre Persiaran Raja Muda,

Seksyen 7, 40000 Shah Alam Tel: 03-5522 5331 (Dean), 5242 (Asst. Registrar), 5333 (Coursework), 5244 (Research)

Faks (Fax): 03-5522 5335 Laman Web (Web Site): http://www.ipsis.uitm.edu.my

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IGS FORM / RMP / 009 (Pin 2007)

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