ST:

STUDENTS SERVICE CENTER

EXTENSION OF STUDY PERIOD FORM

STUDENT ID
NAME
PROGRAMME
PASSPORT NO. (FOR
INTERNATIONAL STUDENT ONLY)
CONTACT NO .
PENDING SUBJECT/S:
(Kindly bring your transcript/result online when meeting your facultys Administrator)

NO

SUBJECT CODE

SUBJECT NAME

TRIMESTER
THAT THE SUBJECT/S WILL
BE OFFERED

1
2
3
4
5
6
7
8
9
10
11
12
13
14

STUDENTS SIGNATURE: _________________________

DATE : ____________________

REMARK BY THE FACULTY:

Tentatively, the above student will be graduated in _____________________________ (Month & Year)

VERIFIED BY : _____________________________________ DATE : ________________________

(with stamp)
* The information above will be updated in the Student Profile.

SSC/FORM/04
Ver.1, Rev.0
03/03/2014