UNIVERSITI TEKNIKAL MALAYSIA MELAKA

PUSAT PENGAJIAN SISWAZAH/Centre for Graduate Studies

UTeM.29/1/25
Sila lekatkan sekeping gambar terbaru (WAJIB) Please affix a recent photograph (COMPULSARY)

BORANG PERMOHONAN SKIM ZAMALAH UTeM

UTeM FELLOWSHIP APPLICATION FORM
NOTA: NOTES: 1. 2. Sila taip atau tulis (dengan pen mata bulat).(Please type or print boldly (preferably with a ball-point pen)). Untuk mempercepatkan proses, sila sertakan maklumat lengkap yang menyokong permohonan. (To expedite the application, please provide all information requested.)

A. MAKLUMAT PERIBADI (PERSONAL PARTICULARS) Nama penuh (HURUF BESAR) (Full Name (IN BLOCK LETTERS)).

Alamat Surat-menyurat (Correspondence Address):

Telefon (Telephone): Rumah (Home): E-Mel (E-Mail): Negara Tempat Lahir: (Country of Birth): Warganegara (Nationality) Tarikh Lahir (Hari/Bulan/Tahun): Date of Birth(Day/Month/Year): Jantina (Gender): Umur (Age): No. Pasport / K.P: (Passport No. / IC No.) Agama (Religion): H/P:

Bangsa (Race):

Status Perkahwinan (Marital Status):

B. BUTIRAN PENGAJIAN (STUDIES DETAILS) Sila lampirkan salinan transkrip dan Ijazah yang telah disahkan (Please attach certified copy of certificate degree and transcript) Peringkat Pengajian: (Degree Applied For) Doktor Falsafah (PhD) Fakulti : (Faculty) Bidang : (Field) Bidang Tujahan: (Thrust Area) Manufacturing Process, Technology & Design Automotive Engineering & Energy Communication & Computer Engineering Technology Management & Entrepreneurship Tajuk Penyelidikan : (Research Title)

Sarjana (Masters)

Industrial Automation & Robotic Advance Computing Technologies Soft Skills For Engineers & Technologists

* Sila lampirkan Rancangan Penyelidikan yang telah disahkan oleh Penyelia Please attach Research Proposal which has been certified by Supervisor Tarikh Mendaftar: Date of Registration Tarikh Dijangka Tamat: Expected Date of Graduation

C. PERAKUAN PEMOHON (DECLARATION)

Saya mengaku bahawa butir-butir yang diberikan dalam permohonan ini adalah benar. (I hereby declare that all information given are true.) Tandatangan (Signature): ................................................................................. Nama (Name): ............................................................................................................................................ ............................................................................................................................................ Tarikh (Date): ......................................................................................................

D. SOKONGAN PENYELIA (SUPERVISORS RECOMMENDATION) Nama Penyelia (Supervisor Name) Jabatan/Fakulti (Dept./Faculty) Ulasan (Statement of Recommendation) Tandatangan Penyelia & Cop Rasmi (Supervisors Signature & Official Stamp) Tarikh (Date)

E. ULASAN DEKAN FAKULTI (DEAN OF FACULTY COMMENT) Ulasan Dekan Fakulti (Dean of Faculty Comment) Tandatangan Dekan & Cop (Deans Signature & Official Stamp) Tarikh (Date) F. KEPUTUSAN PANEL PEMILIH (DECISION OF SELECTION PANEL) Keputusan (Decision) Ulasan (Comment) Tandatangan Pengerusi Panel Pemilih (Signature of Selection Panel) Chairman of Berjaya Succesfull Tidak Berjaya Not Successfull

Mesyuarat Bilangan (Meeting Number) Tarikh (Date)

ARAHAN DAN PANDUAN MENGISI BORANG PERMOHONAN SKIM ZAMALAH UTeM INSTRUCTIONS AND GUIDELINES TO FILL UTeM FELLOWSHIP SCHEME APPLICATION FORM Pemohon adalah diminta membuat semakan berikut sebelum menghantar borang permohonan. Permohonan hendaklah mengikut turutan semakan ini. Applicants are required to do these checks before submitting the application form. Application must be sent according to the sequence of this check-list. Borang Permohonan Zamalah - 2 Salinan UTeM Fellowship Application Form (2 copies) Rancangan Penyelidikan yang telah disahkan oleh penyelia 2 Salinan Research proposal which has been certified by Supervisor (2 copies) Salinan Kad Pengenalan/Pasport - 2 salinan Certified copy of Identification Card/Passport (2 copies) Salinan Sijil Akademik (Ijazah, salinan transkrip peperiksaan) yang telah disahkan - 2 salinan Certified copy of Academic Certificates (Degree, Examination Transcript) (2 copies) Salinan surat tawaran pengajian di UTeM 2 salinan A copy of offer letter to study at UTeM (2 copies)

Permohonan yang lengkap hendaklah dihantar kepada:(Please submit completed application form to):

Dekan Pusat Pengajian Siswazah Universiti Teknikal Malaysia Melaka Hang Tuah Jaya, 76100, Durian Tunggal, Melaka, MALAYSIA.

Dean Centre For Graduate Studies Universiti Teknikal Malaysia Melaka Hang Tuah Jaya, 76100, Durian Tunggal, Melaka, MALAYSIA.

*NOTA(NOTE): Borang dan/atau dokumen yang tidak lengkap akan melambatkan proses kelulusan. (Incomplete form and/or documents will delay the approval process)