PLMI/PPG/B08/Pin01/April2022
BORANG KESEDIAAN MENERIMA PELAJAR PROGRAM PERANTIS GURU (UPSI)
STUDENT ACCEPTANCE FORM FOR TEACHER APPRENTICE PROGRAMME (UPSI)
TARIKH PPG : ______________________ SEHINGGA ______________________
Date of PPG
to
1. MAKLUMAT SEKOLAH/INSTITUSI / SCHOOL/INSTITUTION INFORMATION
Nama Sekolah/Institusi /
Name of School/Institution
: ________________________________________________________________________________
Alamat / Address
: ________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Nombor Telefon / Phone Number
: ________________________________________________________________________________
E-mel / E-mail
: ________________________________________________________________________________
Maklum Balas Penempatan [Tandakan (√) pada petak yang berkenaan]
Placement Feedback (Tick ( √ ) where relevant]
Menerima / Accept
Menolak / Reject
2. MAKLUMAT PELAJAR (diisi oleh pelajar) / STUDENT INFORMATION (completed by student)
Nama / Name
: ________________________________________________________________________________
No. Matriks / Matrix No.
: ________________________________________________________________________________
No. Kad Pengenalan / IC No.
: ________________________________________________________________________________
No. Telephone / Phone number
: ________________________________________________________________________________
Emel / Email
: ________________________________________________________________________________
Program / Programme
: ________________________________________________________________________________
Fakulti / Faculty
: ________________________________________________________________________________
SESI / SESSION
*potong tidak berkenaan /
cross unrelated
: PPG1 (1 minggu) / PPG1 (1 week)
: PPG1 (2 minggu) / PPG1 (2 weeks)
: PPG2 (3 minggu) / PPG2 (3 weeks)
: PPG2 (4 minggu) / PPG2 (4 weeks)
3. PENGESAHAN PIHAK INSTITUSI / INSTITUTION CONFIRMATION
Tandatangan Pengetua / Pengarah / Guru Besar
Signature of Principal / Director / Headmaster
Cop Rasmi / Official Stamp :
….................................................................................
Nama / Name :
Tarikh / Date :
Catatan :
Note :
Borang yang telah lengkap diisi hendaklah disimpan sebagai rujukan pelajar dan penyelaras.
Completed form must be kept for referance purposes of student and coordinator.