20170530103118Lampiran 2 Borang HU (Pingat Emas PhD)

LAMPIRAN 2

BORANG PENCALONAN HADIAH UNIVERSITI
NOMINATION FORM FOR UNIVERSITY AWARD FOR
UNIVERSITY AWARD

PERIHAL HADIAH
DESCRIPTION OF AWARD
Nama Hadiah
(Name of Award)

PINGAT EMAS DOKTOR FALSAFAH
(DOCTOR OF PHYLOSOPHY GOLD AWARD)

Spesifikasi Hadiah
(Specification of Award)

Pingat Emas dan Hadiah Wang Tunai RM3,500
(Gold Medal and RM3,500 Cash Amounting RM3,500)

Syarat Kurniaan

(Condition of Award)

Tesis PhD Terbaik.
(Best PhD Thesis)

Kriteria Pemilihan
(Selection Criteria)

1. Calon hendaklah telah menerbitkan sekurang-kurangnya tiga (3) kertas
kerja dalam jurnal yang mana salah satunya hendaklah di peringkat Q2.
2. Tesis calon hendaklah mempunyai nilai komersil atau nilai polisi atau nilai
fundamental.
3. Tesis calon hendaklah memberi impak kepada masyarakat dan industri.
4. Calon hendaklah mempamerkan ciri-ciri kepimpinan dalam kegiatan pelajar.
----------------------------------------------------------------------------------------------------1. Candidate must have published at least 3 articles in journals of which one of
those must be in Q2 Journal.
2.

The candidate’s thesis must have either commercial value or policy value
or fundamental value.

3.

The candidate’s thesis must have impact on community and industry.

4.

Candidate must have demonstrated leadership ability in student activities).

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1.
2.
Nama Hadiah
:
PINGAT EMAS DOKTOR FALSAFAH

3.
(Name of Award)
(DOCTOR OF PHYLOSOPHY GOLD AWARD)
4.
5.
MAKLUMAT PERIBADI CALON
(PERSONAL DETAILS OF CANDIDATE)
Nama
(Name)

:

No. K.P/No. Pasport
(I.C. No. /Passport No.)

:

Tarikh Lahir
(Date of Birth)

:

Bangsa
(Race)

:

Agama
(Religion)

:

Warganegara
(Citizenship)

:

E-meail
(Email)

:

Nombor Matrik
(Matric No.)

:

Gambar
Photo

Nombor Telefon (bimbit)

:

Mobile Number
Bidang Pengajian
(Field of Study)

:

Semester Kemasukan
(Admission Semester)

:

Tempoh Pengajian
(Duration of Study)

:

Tajuk Tesis
(Tesis Title)

:

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1.

MAKLUMAT PENERBITAN DARI PENYELIDIKAN PHD
(INFORMATION ON PUBLICATIONS DRAWNDERRIVED FROM PHD RESEARCH)
Bil
(No.s)

Tajuk artikel
(Title of Article)

Nama Jurnal
(Name of Journal)

Tanda 'X'
untuk
jurnal
Q1
(Type in
Tick ‘X’

for Q1
journal)

Nyatakan
Status
Penerbitan
(State
Publication
Status)
P : Published
A : Accepted

i.

ii.

iii.

iv.

v.
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vi.

2.

PERAKUAN FAKULTI/INSTITUT
(FACULTY/INSTITUTE ENDORSEMENTrecommendation)
i.

Nilai Komersil atau
nilai fundamental
yang dihasilkan
dalam tesis
(Commercial or

fundamental values
derived from the
tesis)

Sila terangkan/Please describeelaborate

ii.

Impak kepada
masyarakat/industri

Sila terangkan/Please describeelaborate

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(Impact onto
Community/industry

)

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3.

SENARAIKAN PERKARA BERIKUT:
(LIST THE FOLLOWING)
Peringkat
(Level)
i.

Lain-Lain Aktiviti
(Other Activities)
 Seminar yang
dihadiri
(Seminars
Attended)
 Anugerah diterima
(Awards
Received)
Penglibatan dalam
Persatuan/kegiatan
ko-kurikulum
(Involvement in
societies or any
other co-curricular
activities)

ii.

Penglibatan dalam
Persatuan/kegiatan
ko-kurikulum
(Involvement in
societiesy or any
other cocurricularum
activities)

Lain-Lain Aktiviti
(Other Activities)
 Seminar yang
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dihadiri
(Seminars
Attended)
 Anugerah diterima
(Awards
Received)

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PERAKUAN DAN PENGESAHAN
OLEH DEKAN FAKULTI/PENGARAH INSTITUT
(ACKNOWLEDGEMENT AND VERIFICATION
BY DEAN OF FACULTY/DIRECTOR OF INSTITUTE)
Saya mengaku segala maklumat yang diberi adalah benar dan saya juga faham sekiranya ada
maklumat yang tidak benar, pencalonan ini akan dibatalkan dengan serta merta.
(I declare that all information provided is true and I also understand that if any information is incorrect or
false, the candidature will be cancelled with immediate effect).

Tandatangan dan Caop ;
(Signature and Stamp)
Nama :
(Name)
Tarikh:
(Date)

 Pengesahan permohonan hendaklah dibuat oleh Dekan Fakulti/Pengarah Institut,
Universiti
Putra Malaysia.
 Sila sertakan satu salinan tesis dan satu salinan sijil yang telah disahkan bagi setiap penglibatan
aktiviti calon.
 Bagi penglibatan yang tidak mempunyai sijil, perlu disertakan surat pengesahan daripada
Dekan/Pengarah/Penyelia calon.
 Verfification of the application shall be made by Dean of Faculty/Director of Institute, Universiti
Putra Malaysia.
 Please attach a copy of thesis and a certified copy of each activity’s certificate.
 For activities with no certificates, a verification letter from the candidate’s Dean/Director/Supervisor
must be provided.

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