PERMOHONAN PELANJUTAN

(APPLICATION FOR EXTENSION)

Sesi..Semester.
(Session) (Semester)

Sila tandakan ():

Please tick ():

Skim Biasiswazah (SB)

Fellowship Scheme

Skim Biasiswa Universiti Malaya (SBUM)

University of Malaya Fellowship Scheme

Skim Bantuan Kewangan Siswazah Lanjutan (SBK)

Scholarship Scheme

Sasakawa Young Leaders Fellowship Fund (SLYFF)

BAHAGIAN I (UNTUK DILENGKAPKAN OLEH CALON)

Part I (To Be Completed by the Candidate)

A. Butir- Butir Calon

(Details of Candidate)

Nama Calon : ......................................................................................................................

(Name of Candidate)

Akademi/Institut/Fakulti/Pusat: ..........................................................................................
(Academy/Institute/Faculty/Centre)

Nombor Pendaftaran:
(Registration Number)

Sarjana PhD

Tarikh Mula Memegang Skim:

(Date of Commencement of Scheme)

a) Pelanjutan Pertama: .. hingga

(First extension)

b) Pelanjutan Kedua: . hingga .

(Second extension)

c) Pelanjutan Ketiga: .... hingga ..

(Third extension)

d) Pelanjutan Keempat: .hingga..

(Fourth extension)

B. Kursus (Courses)

1. 2.

Nama Penyelia/Penasihat Program:

(Name of Supervisor/Programme Advisor)

Kursus - kursus pengajian yang perlu diambil:

(Courses to be taken)

Kod Kursus
(Course Code)

Tajuk Kursus
(Course Title)

Semester/Sesi
(Semester/Session)

2.

Peperiksaan yang akan diambil:

(Examinations to be taken)

Kod Kursus
(Course Code)

Tajuk Kursus
(Course Title)

Semester/Sesi
(Semester/Session)

4 Kod Kursus
(Course Code)

Peperiksaan yang telah diambil

(Examinations taken)

Tajuk Kursus
(Course Title)

Tarikh Peperiksaan
(Date of Examination)

Gred
(Grade)

Tarikh Peperiksaan Tambahan

(Date of Supplementary Examination)

Gred
(Grade)

Sila sertakan salinan slip keputusan peperiksaan (Please attach your examination result slip)

C. Laporan Kemajuan Penyelidikan Oleh Calon

(Research Progress Report By Candidate)

Bidang Penyelidikan : .........................................................................................................

(Field of Research)

Tajuk Penyelidikan (Jika Ada): ..........................................................................................

(Research Title, If Available)

Nama Penyelia Pertama: .................................................................................................

(Name of First Supervisor)

Nama Penyelia Kedua/Bersama*: ...................................................................................

(Name of Second/Co-Supervisor*)
*Batalkan yang mana tidak berkenaan (Delete where necessary)

Perkara
(Item)

Laporan Calon
(Candidates Report)

Mengumpul Kesusasteraan
(Literature Review)

Rekabentuk dan Pembangunan Projek

(Design and Development of Project)

Mengumpul dan Menganalisa Data

(Data Collection and Analysis)
Sertakan lampiran jika ruang tidak mencukupi (Attach a separate sheet if space is insufficient)

Penulisan Tesis/Disertasi (Thesis/Dissertation Writing) Bilangan Bab yang Dicadangkan : .....................................................................................

(Number of Proposed Chapters)

Kemajuan Penulisan
(Writing Progress)

Laporan Calon
(Candidates Report)

Bilangan Bab Yang Siap

(Number of Chapters Completed)

Bilangan Bab Yang Diserah Kepada Penyelia

(Number of Chapters Submitted To Supervisor)

Bilangan Bab Yang Belum Siap Ditulis

(Number of Incomplete Chapters)
Sertakan lampiran jika ruang tidak mencukupi (Attach a separate sheet if space is insufficient)

Tarikh Jangkaan Tesis/Disertasi Diserahkan :

(Expected Date of Thesis/Dissertation Submission)

Masalah Dihadapi :
(Problems Encountered)

............... ...............

D.Sumbangan Akademik
(Academic Contributions)

i.

Pembentangan Kertas Penyelidikan/Penyertaan dalam Seminar atau Bengkel

(Paper presentations/Seminars or Workshop attended)

Ya/Yes

Tidak/No

Jika Ya, sila berikan butiran lanjut dan sertakan bukti

(If Yes, please provide details and attach evidence)

ii.

Penerbitan
(Publication)

Ya/Yes

Tidak/No

Jika Ya, sila berikan butiran lanjut dan sertakan bukti

(If Yes, please provide details and attach evidence)

iii. Membantu dalam tutorial/amali/kerja lapangan
(Assist in tutorials/practicals/field work)

Ya/Yes

Tidak/No

Jika Ya, sila sertakan butiran lanjut contoh seperti bilangan jam, nama kursus
(If Yes, please provide details e.g. no. of hours, name of course)

Pengakuan Pemohon:
(Applicants Declaration)

Saya mengaku bahawa keterangan yang diberikan di atas adalah tepat dan benar. Saya akui bahawa pihak Universiti Malaya berhak untuk menolak permohonan ini tanpa perlu memberi alasan, atau menarik kembali pemegangan Skim sekiranya didapati mana-mana keterangan yang saya berikan tidak benar.
(I declare that all information given in this application is accurate and true. I agree that the University of Malaya reserves the right to reject this application without giving any reasons or to withdraw the offer at any time if any information given is found to be untrue.)

Tarikh : .
(Date)

Tandatangan Calon : (Candidates Signature)

Bahagian II Laporan Penyelia Pertama/Penyelia Kedua/Bersama*

Part II (First Supervisor/Second/Co-Supervisors Report)

Penilaian Terhadap Calon

(Students Rating)

Sila Gunakan Skala Berikut :

(Please Use the Following Scale)

Lemah
(Poor)

Sederhana
(Fair)

Baik
(Good)

Sangat Baik
(Very Good)

Cemerlang
(Excellent)

Penyelia Pertama
(First Supervisor

Penyelia Kedua/Bersama*
(Second/CoSupervisor)

Penyelia Pertama
(First Supervisor)

Penyelia Kedua/Bersama*
(Second/CoSupervisor)

(a)

Ketekunan
(Commitment)

(e)

Kecekapan Bahasa Tesis/Disertasi

(Thesis/Dissertation Language Proficiency)

(b)

Kehadiran
(Attendance)

(f)

Kebolehan Bekerja Sendiri

(Ability To Work Independently)

(c)

Minat
(Interest)

(g)

Prestasi Keseluruhan
(Overall Performance)

(d)

Mutu Kerja dan Kecekapan

(Work Quality and Efficiency)

*Batalkan yang mana tidak berkenaan (Delete where necessary)

Kemajuan Penyelidikan (Research Progress) Perkara

(Item)

Laporan Penyelia Pertama

(First Supervisors Report )

Laporan Penyelia Kedua/Bersama*

(Second/Co-Supervisors Report )

Mengumpul Kesusasteraan
(Literature Review)

Rekabentuk dan Pembangunan Projek

(Design and Project Development)

Mengumpul dan Menganalisa Data

(Data Collection and Analysis)

Status Penulisan Tesis/Disertasi

(Status of Thesis/Dissertation Writing)
Sertakan lampiran jika ruang tidak mencukupi (Attach a separate sheet if space is insufficient) *Batalkan yang mana tidak berkenaan (Delete where necessary)

Ulasan Penyelia Pertama mengenai permohonan pelanjutan Skim Biasiswa Universiti Malaya.
(Comment of First Supervisor concerning the application for extension of University of Malaya Fellowship Scheme)

............................................................................................................................................. .............................................................................................................................................
Ulasan Penyelia Kedua/Bersama mengenai permohonan pelanjutan Skim Biasiswa Universiti Malaya
(Comment of Second/Co-Supervisor concerning the application for extension of University of Malaya Fellowship Scheme)

............................................................................................................................................. .............................................................................................................................................
Penyelia Pertama
(First Supervisor)

Penyelia Kedua/Bersama*
(Second/Co-Supervisor)

Memuaskan
(Satisfactory)

Kemajuan Calon :
(Candidates Progress)

Sederhana
(Moderate)

Tidak Memuaskan
(Unsatisfactory)

Tarikh
(Date)

Tandatangan Penyelia Pertama

(First Supervisors Signature)

Tarikh
(Date)

. Tandatangan Penyelia Kedua/Bersama*

(Second/Co-Supervisors Signature)

Bahagian III
Part III

Perakuan Ketua Jabatan

(Head of Department/Programme/Projects Recommendation)

Disokong /Tidak Disokong * Pelanjutan Skim Biasiswa Universiti Malaya

(Support/Do Not Support * Extension of University of Malaya Fellowship Scheme)

Tarikh
(Date)

Tandatangan Ketua Jabatan

(Head of Department/Programme/Projects Signature)

Bahagian IV
Part IV

Perakuan Pengarah/Dekan
(Director/Deans Recommendation)

Disokong/Tidak Disokong * Pelanjutan Skim Biasiswa Universiti Malaya

(Support/Do Not Support * Extension of University of Malaya Fellowship Scheme)

Tarikh
(Date)

Tandatangan Pengarah/Dekan
(Director/Deans Signature)

*Batalkan yang mana tidak berkenaan (Delete where necessary)

Bahagian V (Untuk dilengkapkan oleh Dekan, Institut Pengajian Siswazah)

Part V (To Be Completed by Dean, Institute of Graduate Studies)

Permohonan Diluluskan Untuk Semester: .. Sesi: ..

(Application Approved for Semester Session)

Permohonan Tidak Diluluskan

(Application Rejected)

Tandatangan
(Signature)

: Date:
(Date)

Nama
(Name)

: . : .

Cop
(Stamp)

HH/nhar: Extension