Internship Placement Registration Form
Name *
Your answer
ID *
Your answer
NRIC/ Passport No. (with hyphen) *
Your answer
Gender *
Nationality *
Your answer
Faculty/ School *
Program Code *
(Eg: BMAUH)
Your answer
Current Semester *
Handphone Number *
Eg: 012 - 3338888 (Please place a Hypen after the first 3 digits)
Your answer
E-mail Address
(Please proofread)
Your answer
Mailing Address *
(Please proofread)
Your answer
Internship Period *
(Please state starting date and Ending date (Format: DD/MM/YY - DD/MM/YY)
Your answer
Name of Person to Contact In Case of Emergency *
Your answer
Internship Course Code
The above person to contact during emergency is my... *
Handphone Number of the Emergency Contact Person *
Your answer
Mailing Address of the Emergency Contact Person *
Your answer
Internship Placement Agreement
I ( name as stated in this form), hereby acknowledge that I have read, understood and agreed the contents of the Internship Handbook. I will look for my own placment (Self- internship Placement) and update Employer Relations on the status of the host company prior to the dateline. Thereafter, the University will take over the placement and all decision made is final.
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