UTM Student Academic Visit Online Application Form

Application for Academic Visit to UTM

University Name *

Country

Name of officer in charge (International Office) *

This should be the contact from the International Office in your university.

International Office Contact Number *

International Office Email Address *

Name of the Group Leader *

Group Leader Contact Number *

Group Leader Email Address *

Programme date from *

To *

Host Faculty *

This form can be filled up as a group.

Programme Background *

Objectives *

(All participant names must be listed)

Name *

Gender *

Passport Num. *

Year/Course *

Email *

Status (Staff/ Student) *

Date

Activity *

Details *

If you are human, leave this field blank.