Official Visit Request Form, Universiti Sains Islam Malaysia (USIM)
USIM 'Alamiyyah is responsible for coordinating official visits by international representatives to Universiti Sains Islam Malaysia (USIM). If you would like to schedule a visit to USIM, please kindly complete the form below, providing as much details as possible. The information will help us assessing your request and if approved, it will help us facilitating your visit. All visit requests MUST require approval and confirmation from us as an indication for acceptance.

USIM ‘ALAMIYYAH, UNIVERSITI SAINS ISLAM MALAYSIA (USIM)
Phone: +606 797 8652 or +606 797 8655 Fax: +606 797 8650 Email: alamiyyah@usim.edu.my URL: http://alamiyyah.usim.edu.my

URL of this form : https://goo.gl/forms/JL5yDqKrPDw5esN73

Email address
Institution Name
Your answer
Name (Contact Person)
Your answer
Address
Your answer
Office Phone Number
Your answer
Mobile Phone No
Your answer
Website(s)
Your answer
Proposed Start Date Time
MM
/
DD
/
YYYY
Time
:
Finish Date Time
Estimated time is acceptable
MM
/
DD
/
YYYY
Time
:
Total Members in Delegation
Your answer
Name(s) & Designation Of Delegation Member(s)
Your answer
What are the main objectives of your visit?
Please state any particular fields or disciplines of study
Your answer
Person(s) or department(s) you would like to meet with while on campus
Your answer
Do you require an invitation letter to obtain your visa?
Additional Information:
Your answer
Thank you! We will contact you very soon.
USIM ‘ALAMIYYAH, UNIVERSITI SAINS ISLAM MALAYSIA (USIM) Phone: +606 797 8652/ 8655 Fax: +606 797 8650 Email: alamiyyah@usim.edu.my
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