APPLICATION FORMFACILITATOR FOR MINGGU ALUAN SISWA JANUARY 2016

(ONLY HARD COPY FORM ACCEPTED)

Name

ID no ProgramYear & Semester GPA/ CGPA

UTP Village address

Phone No. (Home & HP) E – mail address

Your 4 month semester break

Your internship (expected Year & Semester)

Willingness to be Senior Buddy for I semester

YES NO

Experience as facilitator (if any)

Highest achievements/ post in club/ events

Level of commitment to be a facilitator(Please Circle)

LOW COMMITMENT HIGH COMMITMENT

1 2 3 4 5 6 7 8 9 10

Any additional skills? I.e.: martial arts, public speaking, drama, theatre etc.

WHICH DEPARTMENT WOULD YOU LIKE TO APPLY FOR? (KINDLY RANK YOU MOST THREE (3) PREFERRED DEPARTMENT)

WelfareRegistrationCeremony And ProtocolDisciplineLogisticReligious And MoraleActivity And Role playSports And GamesAccommodationDesktop And PublishingFood And Beverages

Signature, Date,

_________________________________ __________________________________

MAS JAN 2016#13-20 JAN- MAS#10-12 JAN- TOT

Closing date 10 DECEMBER 2015

COUNSELING AND STUDENTS DEVELOPMENT UNITUNIVERSITI TEKNOLOGI PETRONASTEL: 05 - 3688438FAX: 05 - 3667746E - MAIL: jalil_abdullah@petronas.com.my

PHOTO COMPULSORY!

(Reject without photo)