Graduate

Assistant Scheme

GA0
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001

Before applying, please refer to the application guidelines and instructions

at www.ips.usm.my
Please submit your application to the respective school/centre you are
A.

APPLICANTS PARTICULARS

1. 1. Name
2.

I/C / Passport No.

3. Mailing Address

4.

E-mail

5. Contact Number

6. Please indicate your current Degree with USM

7.

Registration date :

8.

Matric No :

Masters

Ph.D

9. School/Centre :

10. Research Area:

11. Research Title:

12. Main Supervisor: (if any)

13. Co-Supervisor: (if any)

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Graduate
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B. ACADEMIC BACKGROUND
(Kindly attach certified copies of all academic transcripts)
Bachelors Degree

Masters Degree

1. University
(state full name)
2. Duration

3.

From

From

To

To

Programme Mode

(for Masters Degree; please

state :
coursework/research/mixedmode)

4. Area of Research (if

any)
5. CGPA/Class/Grade

C. PUBLICATION ACTIVITIES (if applicable)

Indicate your publications details in journals and kindly attach the hard copy of your published articles
(if any)
Articles Published (reference format)

ISI/Scop
us
Listings

Other
Listin
gs

Impac
t
Facto
r

1.
2.
3.
4.
5.

D. FINANCIAL SUPPORT / ASSISTANCE (if applicable)

Indicate any financial assistance you have currently. Failure to declare will affect your application
1. Type (circle where related)

Scholarship/Loan/Research Assistant/Research
Officer

2. Name of Sponsor/Awarding
body/Research Grant
3. Amount

RM

4. Duration

From
:

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Assistant Scheme

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E. RESEARCH EXPERIENCE (if applicable)

Indicate your previous experience in research
Dates
From / To

Institution & Country

(if any)

Research undertaken

F. DECLARATIONS
F1. I declare that I am not a recipient of any other scholarship or financial aid
Name :
(BLOCK LETTERS)
Signature :
Date :
F2. I hereby certify that all information given in this application is complete and correct to the best of
my knowledge
Name :
(BLOCK LETTERS)
Signature :
Date :

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Graduate
Assistant Scheme

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--------------PLEASE DETACH THIS SECTION AND FORWARD TO YOUR MAIN SUPERVISOR (if
any)-----------

To Supervisor: Please mail this confidential report directly to Dean/Director of

the respective school/centre the student is applying to :-

G. SUPERVISORS REPORT
(Confidential report to be completed Main Supervisor)
1.

Name

2. School/Centre
3. Candidates Name
4. Candidates Research Area
5.

Research Programme Related to Candidates Research

6. Please State :a.

Candidates involvement and ability to conduct research

..
b.

Potentials of the research area

..

.
c. Relevancy of research title to sustainability (please circle)
Not relevant at
all

Very relevant

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Assistant Scheme
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d. Supervisors Endorsement
Recommended

Not recommended

SIGNATURE :
DATE :
OFFICIAL STAMP :

-PLEASE LEAVE THIS SECTION BLANK FOR OFFICIAL USAGE-

H. (SCHOOL/CENTRE) DEANS / DIRECTORSS ENDORSEMENT

Recommended for Graduate Assistants Scheme
Graduate Assistants Scheme

Not Recommended

SIGNATURE :
DATE :
OFFICIAL STAMP :

Please state the assignments that can be assigned to this candidate during his/her term as a Gradua
Assistant
1.
2.

3.

4.

I. THIS SECTION IS FOR THE ENDORSEMENT OF INSTITUTE OF POSTGRADUATE STUDIES

Endorsement by Dean of Institute of Postgraduate Studies
Approved

Not Approved

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Graduate
Assistant Scheme

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SIGNATURE :
DATE :
OFFICIAL STAMP :

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GA01