SCHOOL OF HOSPITALITY &CREATIVE ARTS (SHCA)
BORANG PERMOHONAN MENJALANKAN AKTIVITI DI CHILING
WATERFALL, KUALA KUBU BHARU
APPLICATION FORM TO CONDUCT ACTIVITY IN CHILING
WATERFALL,KUALA KUBU BHARU
MAKLUMAT PEMOHON
APPLICANT INFORMATION
1. Nama
Name :
2. No. K.P./No. Matrik/No. Staf
I.C. No./Matric No./Staff No. :
3. Nama Institut/Agensi/Fakulti
Institute/Agency/Faculty’s Name :
4. Alamat Surat-Menyurat
Mailing Address :
5. No. Telefon Bimbit No. Telefon Pejabat
Hand Phone No. : Office Phone No. :
6. Alamat Emel
Email Address :
MAKLUMAT AKTIVTITI
ACTIVITY INFORMATION
* Sila tandakan di mana yang berkenaan
* Please tick where applicable
7. Tujuan Penggunaan
Usage Purpose :
* rujuk senarai semak bagi dokumen sokongan yang perlu dilampirkan
refer to the checklist of supporting documents to be attached
Pendidikan Kod Kursus/Subjek/Program
Education Course Code/Subject/Program :
Pengembangan Nama Program
Extension Program’s Name :
Lain-Lain Aktiviti Nama Program
Others Activity Program’s Name :
8. Kemudahan
Facilities
Tapak Perkhemahan Prasarana Penginapan Lain-lain (nyatakan)
Campsite Accommodation Others (please state) ………………………
Bilik Seminar Dewan
Seminar Room Hall
9. Tarikh Penggunaan (dari) (sehingga)
Date of Usage : (from) (until) :
10. Bermalam Ya Tidak
Overnight Yes No
11. Bilangan Pengguna Pegawai/Staf Peserta/Pelajar
No. of Users Officer/Staff : Participants/Students :
Saya mengaku bahawa semua maklumat yang telah diberikan di atas adalah benar dan bersetuju
dengan syarat-syarat yang telah ditetapkan seperti di Lampiran A.
I declare that all the information above is true and agree to all conditions as stipulated in Appendix A.
TANDATANGAN PEMOHON PENGESAHAN KETUA JABATAN/MAJIKAN
APPLICANT’S SIGNATURE EMPLOYER/HEAD OF DEPARTMENT’S ENDORSEMENT
Tandatanngan dan Cop Rasmi
Tarikh Signature and Official Stamp
Date :
Tarikh
Date :
Nota / Notes
* Permohonan perlu dikemukakan satu (1) minggu sebelum tarikh aktiviti dijalankan
Applications must be submitted one (1) week before the date of activities
* Pendidikan - Aktiviti yang berkaitan amali kelas, kerja lapangan, lawatan sambil belajar
Education - Activities related to practical , field work, field trip and educational visits
* Pengembangan – Aktiviti berkaitan alam sekitar dan perhutanan, program komuniti, perkhemahan,
program penanaman pokok
* Extension - Activities related to the environment and forestry, community programs, camping, tree
planting program
UNTUK KEGUNAAN PEJABAT
FOR OFFICE USE ONLY
Kelulusan Permohonan : Lulus Tidak Diluluskan
Ulasan :
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Tandatangan dan Cop : ……………………………………………. Tarikh : …………………………………..
Dekan
