PERMOHONAN PENGANJURAN SEMINAR/PERSIDANGAN/BENGKEL/FORUM/PAMERAN DI PERINGKAT DALAMAN UNIVERSITI MALAYA, KEBANGSAAN DAN ANTARABANGSA

BAHAGIAN I - KATEGORI PERMOHONAN Sila tandakan ()

Peringkat Antarabangsa

Peringkat Kebangsaan dan Dalaman Universiti Malaya (UM)

_____________________________________________________________________________ BAHAGIAN II - MAKLUMAT PEMOHON (PUSAT TANGGUNGJAWAB)

Nama Pegawai :

Jawatan :

Jabatan :

PTj :

_____________________________________________________________________________ BAHAGIAN III - MAKLUMAT PENGANJURAN 1. TAJUK SEMINAR/PERSIDANGAN/BENGKEL/FORUM/PAMERAN

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2. TUJUAN

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3. LATAR BELAKANG

(1) Nyatakan latar belakang seminar/persidangan/bengkel/forum/pameran

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(2) Kekerapan diadakan

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(3) Jawatankuasa penganjur

(Sila lampirkan)

4. TUJUAN SEMINAR/PERSIDANGAN/BENGKEL/FORUM/PAMERAN ________________________________________________________________________

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5. ASAS PERTIMBANGAN

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6. BUTIR-BUTIR SEMINAR/PERSIDANGAN/BENGKEL/FORUM/PAMERAN

(1) Tarikh dan Tempat

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(2) Peserta

(Sila lampirkan)

(3) Pembentangan Kertas Kerja (a) Tajuk kertas kerja

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(b) Pembentang kertas kerja berserta dengan latar belakang

(Sila lampirkan)

(4) Program (Brochure)

(Sila lampirkan)

7. IMPLIKASI KEWANGAN

(Sila lampirkan) 8. IMPLIKASI KESELAMATAN

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9. SYOR

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*Nota: Permohonan hendaklah dikemukakan selewat-lewatnya:

3 bulan sebelum tarikh penganjuran - Peringkat Antarabangsa 2 minggu sebelum tarikh penganjuran - Peringkat Kebangsaan dan Dalaman UM

BAHAGIAN IV PERAKUAN KETUA PUSAT TANGGUNGJAWAB

DIPERAKUKAN TIDAK

DIPERAKUKAN

ULASAN : ____________________________________________________________

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______________________________ _____________________ TANDATANGAN & COP Tarikh

_____________________________________________________________________________ BAHAGIAN V - KELULUSAN KELULUSAN NAIB CANSELOR/TIMBALAN NAIB CANSELOR (AKADEMIK & ANTARABANGSA):

DILULUSKAN TIDAK

DILULUSKAN

ULASAN : ____________________________________________________________

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______________________________ _____________________ TANDATANGAN & COP Tarikh

Nota: Pejabat Naib Canselor/Timbalan Naib Canselor (Akademik & Antarabangsa) diminta mengemukakan

kelulusan permohonan ke Bahagian Pentadbiran Pendaftar untuk pemakluman status permohonan ke PTj

yang berkenaan.

BAHAGIAN VI UNTUK KEGUNAAN PEJABAT

Tindakan:

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Ketua Bahagian Pentadbiran Pendaftar

Untuk Diproses

Rujukan Semula