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“CROSS-PLATFORM FOREIGN CORRESPONDENCE”
31 August ‒ 14 September 2019
8 ECTS
990 EUR Includes: tuition, housing, breakfasts and lunches, social and cultural events.
The job of foreign correspondent is one of the most prestigious positions in journalism, and is
being rapidly transformed by emerging technologies. During a two-week simulation, guided by
professionals and academics, students will report back to their home countries and to other
international outlets on the Czech Republic and Central Europe, in a number of formats and
across multiple platforms.
Application deadline: 30 June 2019
Further details: http://summer-school.fsv.cuni.cz/
Contact: [email protected]
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BORANG PERMOHONAN MENGIKUTI PROGRAM MOBILITI / Mobility Programme Application Form
PANDUAN PERMOHONAN/ INSTRUCTIONS
1) Sila lengkapkan borang dan kemukakan kepada Pusat Pengajian/Fakulti/Institut dalam
tempoh tiga(3) bulan sebelum program bermula.
Please fill in the form and submit it to the respective School/Faculty/Institute in 3 months
before the program starts.
2) Sila kemukakan bersama salinan transkrip akademik dan lain-lain dokumen yang berkaitan.
Please attach certified copies of academic transcript or other relevant documents.
A. BUTIRAN PERIBADI/ Personal Details
Nama Penuh/Full Name:
No. KP / IC No. :
Tarikh Lahir/Date of Birth :
Tempat Lahir/Place of Birth : Umur/Age: No. Pasport/Passport No.:
Jantina/
Gender :
Lelaki/Male
Wanita/Female
Taraf
Perkahwinan/
Marital Status:
Bujang/Single
Berkahwin/Married
Bangsa/Race :
Kewarganegaraan/Nationality :
Agama/Religion:
Alamat Tetap/Permanent Address:
Poskod/Postcode :
No. Tel/Phone No.:
Emel/Email:
Waris Terdekat/Next of Kin :
Nama Penuh/Full Name:
Hubungan/Relationship:
Alamat Tetap/ Permanent Address:
Poskod/Postcode :
No. Tel/Phone No.
Rumah/Home:
Pejabat/Office :
Tel. Bimbit/Mobile:
B. BUTIRAN AKADEMIK/ Academic Details
Nama Pusat Pengajian/Fakulti/Institut/ Name of School/Faculty/Institute:
No. Matrik/Matric No:
Nama Program Pengajian / Name of Academic Program:
Semester Pengajian Semasa /Current Semester:
PNGK Terkini/Current CGPA:
Tahun dijangka Bergraduat/Expected year of Graduation:
Nama Penaja (jika ada)/ Name of Sponsor (if any):
Jenis Penajaan/Type of Sponsor:
Gambar (berukuran
pasport)
Recent Photo (Passport Size)
HEA (A) –04
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Anugerah Akademik yang Diterima (jika ada) / Academic awards obtained (if any):
Bil. Nama Anugerah/Name of Award Penganjur/Organiser Tarikh Diterima/
Date Received
1.
2.
3.
4.
5.
Aktiviti Ko-kurikulum atau Khidmat Masyarakat / Curricular or Social Service Activities:
Bil. Nama Aktiviti/Name of Activity Peringkat Penyertaan/
Level of Partictipation
Tarikh/Tahun
Date/Year
Jawatan
Disandang/
Post Held
1.
2.
3.
4.
5.
C. BUTIRAN PERMOHONAN/ Application Details
Nama Universiti Hos/Institusi Dipohon / Name of University Host/Institution Applied:
Tempoh Program /
Period of Study: 1 Semester
2 Semester
Lain-lain
Nyatakan :
Jangkaan Tarikh Bermula /Commencement Date :
Dari/From : Hingga/To :
Senarai Kursus Yang Ingin Diikuti / List of Courses to be taken :
Kod Kursus/
Code Nama Kursus/Course’s Name Nilai Kredit/Credit
D. PERAKUAN PEMOHON/ Applicant’s Declaration
Saya mengaku semua maklumat yang diberikan adalah tepat dan benar / I hereby declare that all the information
given are true and correct.
Tandatangan/ Tarikh/
Signature : Date :
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E. ULASAN PENGERUSI RANCANGAN/ Comment from Program Chaiman
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Tandatangan dan cop/ Tarikh/
Signature and Stamp : Date :
F. PERAKUAN DEKAN/ Verification from The Dean
Disokong/Support Tidak Disokong/Not Support
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Tandatangan dan cop/ Tarikh/
Signature and Stamp : Date :
G. KELULUSAN TIMBALAN NAIB CANSELOR (A&A)/ Approval from Deputy Vice Chancellor (A&I)
Diluluskan/Approved Tidak Diluluskan/Not Approved
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Tandatangan dan cop/ Tarikh/
Signature and Stamp : Date :
H. UNTUK KEGUNAAN PTj PENYELARAS
Pegawai dari UniMAP untuk dihubungi oleh UH /Contact Person from UniMAP :
Nama Penuh/Full Name:
Jawatan/Position:
Pusat Tanggungjawab/ School/Office:
No. Tel/Phone No.
1. Rumah/Home :
2. Pejabat/Office :
3. Tel. Bimbit/Mobile : Emel/Email :
Tindakan Selepas Kelulusan /Action Taken after Approval:
Surat Kelulusan Bersyarat kepada Pelajar yang Diluluskan
Conditional Approval Letter to Student
Surat Makluman kepada Pelajar Yang Tidak Diluluskan
Letter informing Student of non-approval of Application
Mengemukakan Permohonan Pelajar yang diluluskan kepada UH (jika penganjur)
Forwarding of Student’s Approved Application to Host University
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UNTUK DIISI OLEH UNIVERSITI HOS/To be filled by Host University
G. ULASAN DEKAN UNIVERSITI HOS/ Comment from the Dean of Host University
Bersetuju/Agree Tidak Bersetuju/Decline menerima permohonan pelajar ini/this student’s application.
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Tandatangan dan cop/ Tarikh/
Signature and Stamp : Date :
