EIT - REPLY FORM

Appendix IV

Revision No. : 01Effective Date : 01/11/2009

EIT APPLICATION FORM Important: Please submit an original copy of your partial transcript and resume

to EITU along with this form.

PERSONAL INFORMATION

Name:

Matric No. :Passport/ IC No.:

Nationality:Date of Birth:

Hp No.:E-mail:

Gender: Male Female

Permanent Address :

Tel No.:

ACADEMIC INFORMATION

Programme:

Aerospace Automotive Biotechnology Computer & Information Communication Mechatronics Manufacturing Material

Total Credits Earned (including next Sem. II):

Remaining Credits ( after EIT):

Study Year:

Current CGPA:

EMERGENCY CONTACT PERSON INFORMATION

Name :

Relationship:Tel/HP:

Address:

STUDENTS NAME & SIGNATURE

__________________________

Date

for identification purposes, submit one photograph

OFFICE USE ONLY

Application Status:

Approved Not Approved

Reason:

_______________________________________

___________

Programme Coordinator

Engineering Industrial Training Unit Date:

__________________________

Name:

Date: