PUSAT PERUMAHAN PELAJAR

[contact-form-7 id=”1477″ title=”Borang tempahan bilik mesyuarat”]

BORANG PERMOHONAN KOLEJ

SILA BACA SEBELUM ISI : SYARAT-SYARAT PERMOHONAN
1. Borang permohonan yang tidak lengkap dan permohonan melalui telefon tidak akan diproses.
2. Permohonan akan dipertimbangkan tertakluk kepada kekosongan bilik sahaja.

PLEASE READ BEFORE COMPLETING THE FORMS : TERMS & CONDITIONS
1. Application forms which are not completed and application by telephone call will not be processed.
2. Application will be considered subject to rooms availability only.

Saya bersetuju dengan Terma & Syarat yang ditetapkan PPP-UKM / I agree to the terms and conditons.

Gambar Paspot / Passport Photo

Pilih Gambar

Nama (Name)

Jantina (Gender)

Lelaki (Male)

Perempuan (Female)

No Matrik (Matric No)

Tahun Pengajian (Year Of Study)

No Telefon Bimbit (Telephone No)

Fakulti (Faculty)

Agama (Religion)

Negara (Country)

Kolej Asal (Origin Residential College)

Kolej Yang Dipohon (Proposed Residential College)

Alamat E-mel (Email Address)

Alamat Rumah (Home Address)

Sebab Memohon (Reason/s to Apply)

OKU (Jika Berkaitan)

Ya/Yes

Tidak/No

Jika Ya, sila nyatakan kategori OKU. If Yes, please state OKU category.

Lampiran/ Attachment

Choose File

Nota: Jika disebabkan kesihatan, sila lampirkan bersama surat/sijil sakit dari klinik UKM atau mana-mana klinik
Note: For health reason, please attach medical letter/ certificate from UKM or other clinic

PUSAT PERUMAHAN PELAJAR (STUDENT HOUSING CENTRE)

+603 8921 4367