METHODIST COLLEGE KUALA LUMPUR
REQUEST FOR HYBRID LESSONS
P-TL-01 Form 1
Version:2.0
Effective Date: 03/03/2022
DETAILS OF STUDENT
Name:
Admission No.:
(eg: CAL2001007 / ADTP2105007)
(as per MyKad/Passport)
Mobile:
Email:
Name of Program:
Cohort & Class:
(eg: 2108M2, 2201S1)
Academic Session:
(for ADTP & Diplomas)
(eg: Jan 2020 / May 2021)
Complete ALL sections:
(A) Vaccination Status (Please check () the appropriate box and attach a screenshot of your MySejahtera as
evidence):
I am NOT Covid-19 fully vaccinated (not vaccinated with 2 doses of Pfizer/AZ/Sinovac for more than 14 days).
I am fully Covid-19 vaccinated but have not received a booster dose.
I am fully Covid-19 vaccinated and boosted.
(B) Reason for request (Please check () the appropriate box and attach evidence):
One or more of my classes has been sent online and I need to notify the lecturers of my other subjects (attach
email/Teams notification from lecturer(s) that class is being sent online).
I am Covid-positive (attach HSO from MySejahtera/self-test result with date/PCR report with date).
I am a close contact. The Covid-positive person is _________________________ Date of contact: ______________
Others (please explain your situation, provide dates where applicable, and attach evidence if any)
(C) DETAILS OF COURSES
I am taking the following courses in this academic session.
Course Code
(Student’s Signature)
Course Title
Lecturer
(Date)
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METHODIST COLLEGE KUALA LUMPUR
REQUEST FOR HYBRID LESSONS
P-TL-01 Form 1
Version:2.0
Effective Date: 03/03/2022
________________________________________________________________________________________________
FOR OFFICE USE
Please check () the relevant boxes.
ACTION
NAME & SIGNATURE
 Approve
Program Head/Assistant Head:
Hybrid lesson period: ……………………… to ……………………………
 Reject, reason: ….………………………………………………………………...
 The student is informed of the decision.
Program Administrative Staff:
 (If approved) Lecturers are informed.
 The form is forwarded to Teaching and Learning Department.
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DATE