USER EDUCATION PROGRAMMES FORM
Classes will only be conducted on Monday, Wednesday and Friday from 9.00 am to 5.00 pm.

Please submit this form within 3 working days before the expecting date of the class.

Click here for a review of the latest class schedule
http://lib.usim.edu.my/myreserve/

Further information, do not hesitate to contact:

Person in charge: Mohd Jamil Ahmad Mokhtor
Telephone: 06-798 6245
Email: mjamil@usim.edu.my

Your request will be confirmed through email or telephone.
Email address *
DATE OF APPLICATION *
Today
MM
/
DD
/
YYYY
NAME AND TELEPHONE (H/P) *
Example : MOHD JAMIL AHMAD MOKHTOR / 011 283 9096
DEPARTMENT / FACULTY / CENTRE / UNIT *
STAF/MATRIC NUMBER *
SEMESTER/SEMESTER *
Example : SEMESTER 4
KATEGORI PENGGUNA/USER TYPE *
DATE OF CLASS REQUIRED *
Classes will only be conducted on Monday, Wednesday and Friday
MM
/
DD
/
YYYY
TIME (START) *
Classes will only be conducted from 9.00 am to 5.00 pm
Time
:
TIME (END) *
Classes will only be conducted from 9.00 am to 5.00 pm
Time
:
PLEASE SELECT THE CLASS REQUIRED *
REMARKS
Minimum 5 persons for student/ No minimum limit for staff: LIMIT FOR STAF *
Total of Students = Example 10
A copy of your responses will be emailed to the address you provided.
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