APPLICATION FORM FOR NATIONAL COURSES / SEMINARS / CONFERENCES

PROJECT LEADER

Type Of Grant : ______

Vote. No : ______

Project Leader : ______

Duration Of Project : ______to ______

  1. Courses/ Seminars/ Conferences attended must be related with to ongoing research
  2. Application for attending national courses/seminars/conferences must be submit to ORICC One (1) Month before courses/seminars/conferences start.
  3. This application form must be completed in full before submitted ORICC
  4. Reporting about attending courses/ seminars/ conferences must submitted with travel claim form
  5. Applicant shall submit a report to ORICC courses / presentations typed and submitted to ORICC and travel claim form .
  6. Nomination encouraged to attend the conference only to participants who will present a paper .
  7. Applicant are encourage to present paper for attending courses/seminars/conferences

CHECK LIST

Please ()in the appropriate column

Complete application formUTHM/ORICC/R&D/000/2014
Prosiding paper and “Acknowledgement” mustfill in the paper prosiding
Staff Travel Form (BEND / UPY / 004) signed by Leader of PTJ
`
Brochure of Courses/Seminars/ Conferenceswith index information (SCOPUS, ISI THOMSON, IF, ETC)
Information for fees payment
Official Travel Form (BEND / UPY / 004) if used own transport
Flight Ticket Application Form (if needed)
Prove of acceptance letter by organizerfor presenter only
Payment Methods / Cheque Telegraphic Transfer
Beneficiary Name
Bank Name
Bank Address
Account Number
Swift Code
PART C : EXPENSES ESTIMATION (Fill By Applicant)
*please check at Lampiran B

  1. Registration Fee:______
  2. Flight Ticket : ______
  3. Travel Expenses :______
  4. Hotel /day : ______
  5. Meal /day :______
  6. Others:______
TOTAL :
** Applicants should take into account the costs associated with organizational collaboration activity
( industry/ Research Institutes/ universities)

PART F : REMARKS BY THE DEPUTY DEAN / HEAD OF DEPARTMENT (R & D) FACULTY
Tick (  ) at correct box :
1. Paper presented appropriate to the field of research :

Yes

No
2. Level conference organizer based authentication:
(Circle the number on the scale below)

Very low low average high very high
Comment
______
______

Signature and stamp : ______
Date : ______
PART G : RECOMMENDATION BY DEAN / DIRECTOR FACULTY
Tick (  ) in the box :

Recommended
Not Recommended
Comment
______
______

Signature and stamp : ______
Date : ______
PART H : APPROVAL BY ORICC DEAN/ DEPUTY DEAN (R & D)
Tick (  ) in the box :

Approved
Expenses / Sources
Registration Fee / ORICC Fund / Research Grant
Travel / Accomodition / Others Expenses / ORICC Fund / Research Grant

Not Approved
Comment
______
______

Signature and stamp : ______
Date : ______

Pers. UPS/PP

BORANG PENYERAHAN KERTAS KERJA, LAPORAN DAN PENERBITAN-PENERBITAN KEPADA PERPUSTAKAAN UTHM.

  1. Maklumat peserta.

1. Nama :______

2. Fakulti/Jabatan:______

3. Tajuk Seminar/Kursus/Bengkel/Persidangan/Simposium :

______

______

4. Tajuk bahan yang diperolehi :

i.______

ii.______

iii.______

5. Tarikh Seminar/Kursus/Bengkel/Persidangan/Simposium :______

6. Tempat :______

……………………………

Tandatangan dan tarikh.

  1. Pengesahan Perpustakaan.

Adalah dengan ini disahkan bahawa ……………………………………………………………

telah menyerahkan kertas kerja, laporan dan penerbitan-penerbitan yang telah dihadiri kepada Perpustakaan UTHM.

…………………………..

Tandatangan

Nama Pegawai dan cop rasmi.

* Tuntutan perjalanan tidak disahkan sekiranya borang ini tidak diserahkan kepadaUnit Perolehan, Perpustakaan UTHM.