INNOVATIVE PRACTICES IN HIGHER EDUCATION EXPO 2016 (I-PHEX)
Registration Form
1. LEAD INNOVATOR PARTICULARS
NAME *
(With Designation)
Your answer
Experience as Academic Staff in Higher Education *
(Number of years)
Your answer
Nationality *
eg. Malaysian
Your answer
Mobile No. *
eg. +60105205925
Your answer
Office Phone No.
eg. +6072899206
Your answer
Office Fax No.
eg. +6074533678
Your answer
Email Address *
eg. name@utm.my
Your answer
Faculty / Department *
eg. Department of Civil Engineering / Centre for Engineering Education
Your answer
University / Institution *
eg. University of Washington / Imperial College
Your answer
Mailing Address *
eg. Centre for Engineering Education, Level 1 Faculty of Bioscience and Medical Engineering, Cluster Building, 81310 UTM Skudai, Johor Bahru, Malaysia
Your answer
2. MEMBERS
Please list down team members
(No. - Name - NIRC/Passport No. - Affiliation) e.g.: 1. Faizah Jaffri - 811111-01-2222 - UTM
Your answer
3. INNOVATION PARTICULARS
Category *
(Participants may choose only one category. Please refer to the list of categories)
Title *
(eg. Using Active Learning in Mathematics)
Your answer
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