92241 Borang Permohonan Felo Kolej Kediaman 1

UPM/BHEP/SPeP/BR004

SEKSYEN PENEMPATAN PELAJAR
BAHAGIAN HAL EHWAL PELAJAR
UNIVERSITI PUTRA MALAYSIA
Tel : 03-8946 6073/6087

Fax : 03-8942 6472

BORANG PERMOHONAN SEBAGAI FELO/PENOLONG FELO KOLEJ KEDIAMAN

KOLEJ: __________________________

A.

DI ISI OLEH PEMOHON
1. Nama : _____________________________________________2. No. Staf/Matrik :____________
3.

Jawatan

: _______________________________________4. *Taraf Jawatan :Kontrak/Tetap

5.

Tempat bertugas : ___________________________________________________________________

6. No. K/P
: _________________7. Bangsa : ______________ 8. *Jantina:
Lelaki/Perempuan
9. *Status: Kahwin / Bujang 10. Bilangan Anak: _______________ 11. Agama :
________________
12. No. Tel. (B): ____________ 13. No. Tel. (P): ______________14. Email: ______________________
15. *Nama Suami/Isteri:_______________________________ 16. No. Tel. (B): ___________________
17. Pekerjaan : ___________________ 18. Tempat Berkerja : __________________________________
19. Nama Waris : ___________________________________ 20. No. Tel. (B): ___________________
21. Kecenderungan dan Kemahiran : _______________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

__________________________________________________________________________________
__________________________________________________________________________________
__________________________
*Saya pernah / tidak pernah dikenakan tindakan tatatertib.

__________________________
Tandatangan Pemohon

*Potong yang tidak berkenaan

________________________
Tarikh

B.

ULASAN PENGETUA KOLEJ YANG DI POHON
*Sokong / Tidak Sokong
Ulasan : ______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________

_________________________

Tandatangan Pengetua Kolej & Cap

C.

Tarikh

KELULUSAN TIMBALAN NAIB CANSELOR (HEP&A)
*Lulus / Tidak Lulus
Ulasan jika berkaitan: __________________________________________________________
_____________________________________________________________________________

__________________________________________
Tandatangan Timbalan Naib Canselor (HEPA)

& Cap
*Potong yang tidak berkenaan
Sila lampirkan Biodata

___________________________
Tarikh