OPTION

CUIC
NOMINATE
Please ( ∕ )

CENTRE FOR UNIVERSITY –INDUSTRY COLLABORATION (CUIC)

UNIVERSITI UTARA MALAYSIA

ORGANISATION NOMINATION FORM

PRACTICUM SESSION: A______

Name :________________________ Matric Number :___________________

_______________________
Programme :________________________ Current CGPA :___________________
DPP Address :________________________ Majoring (if any) :___________________
Tel. Number Mobile:__________________ Email address :___________________
Home :__________________
Father/Mother:___________

Option 1 Option 2
Organisation’s
Name
Address

Business Type
Tel. Number
Fax Number
Officer In-Charge
Email Address

Date:_____________ Student ‘s Signature:__________________

Note:
1. CUIC reserves the right to nominate students at any relevant organisation.
2. Kindly contact CUIC at +604928 4927/4928/4929/4930 for more information.
3. Please update your Resume (Portal) before sending this form.
 OPTION
CUIC
NOMINATE
Please ( ∕ )

CENTRE FOR UNIVERSITY –INDUSTRY COLLABORATION (CUIC)

UNIVERSITI UTARA MALAYSIA

ORGANISATION NOMINATION FORM

PRACTICUM SESSION: A______
LAW I

Name :________________________ Matric Number :___________________

_______________________
Programme :________________________ Current CGPA :___________________
DPP Address :________________________ Majoring (if any) :___________________
Tel. Number Mobile:__________________ Email address :___________________
Home :__________________
Father/Mother:___________

Option 1 Option 2
Organisation’s
Name
Address

Business Type
Tel. Number
Fax Number
Officer In-Charge
Email Address

Date:_____________ Student ‘s Signature:__________________

Note:
1. CUIC reserves the right to nominate students at any relevant organisation.
2. Kindly contact CUIC at +604928 4927/4928/4929/4930 for more information.
3. Please update your Resume (Portal) before sending this form.
 CUIC
NOMINATE
Please ( ∕ )

CENTRE FOR UNIVERSITY –INDUSTRY COLLABORATION (CUIC)

UNIVERSITI UTARA MALAYSIA

ORGANISATION NOMINATION FORM

PRACTICUM SESSION: A______
LAW II

Name :________________________ Matric Number :___________________

_______________________
Programme :________________________ Current CGPA :___________________
DPP Address :________________________ Majoring (if any) :___________________
Tel. Number Mobile:__________________ Email address :___________________
Home :__________________
Father/Mother:___________

Option 1 Option 2
Organisation’s
Name
Address

Business Type
Tel. Number
Fax Number
Officer In-Charge
Email Address

Date:_____________ Student ‘s Signature:__________________

Note:
1. CUIC reserves the right to nominate students at any relevant organisation.
2. Kindly contact CUIC at +604928 4927/4928/4929/4930 for more information.
3. Please update your Resume (Portal) before sending this form.