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PPL4/SGD

BORANG SEMAKAN GRED (GRED REVIEW FORM) Semester Pertama First


** PROGRAM KERJASAMA/PROGRAM PJJ Kedua Second
Ketiga Third
Sesi Akademik (Academic Session) ………………………………

A. Diisi oleh pelajar (To be filled by student)


Nama Pensyarah UPM
(Name of Lecturer): …………………………………………………………………………………………………………………..
Fakulti Menawarkan Kursus
(Faculty of Course Offered): …………………………………………………………………………………………………………
Kod Kursus PNGK PNG
(Course Code): ………………………………………….. (CGPA): …………………. (GPA): …………………...
Nama Kursus
(Name of course): ………………………………………………………………………………………………………....................
Kolej/Pusat Pembelajaran : ………………………………………………………………………………………….........................

Status Baik Amaran Percubaan


Status: Good Warning Probation
No. Matrik Nama Program Gred Asal
Matric No. Name Programme Original Grade

Saya seperti maklumat di bawah memohon untuk semakan gred kerana


I would like to appeal for a review of my grade because:
…………………………………………………………………………………………………………………………………
Tandatangan pelajar Tarikh
Signature of student: …………………………………………………… Date: ………………………………………
-UNTUK KEGUNAAN UPM-
B. Ulasan Pensyarah* (Lecturer’s Comment)
Gred Baru
New Grade
Gred dikekalkan Bersetuju pinda gred T1/UJ1 T2/UJ2 MID/LL FINAL GRED
Original grade is retained Agree grade be amended

Nyatakan sebab
State reason: ………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
Tandatangan dan Cop Tarikh
Signature and official stamp: ………………………………………………….. Date: ……………………………….
C. Sokongan Ketua Jabatan/Penyelaras Program
Recommendation of Head of Department/ DISOKONG / TIDAK DISOKONG
Programme Coordinator AGREE / NOT AGREE GRADE BE AMENDED

Tandatangan dan Cop Tarikh


Signature and official stamp: ………………………………………………….. Date: ……………………………….
D. Pengesahan Dekan/Timbalan Dekan
Dean’s/Deputy Dean’s verification and confirmation DISOKONG / TIDAK DISOKONG
AGREE / NOT AGREE GRADE BE AMENDED

Tandatangan dan Cop Tarikh


Signature and official stamp: ………………………………………………….. Date: …………………………..
*Sila tandakan ( √ ) pada kotak berkenaan
Please tick ( √ ) where appropriate
**Potong yang tidak berkenaan

NO. EDISI : 1.0 1/1


NO. SEMAKAN : 05
TARIKH KUATKUASA : 01/03/2010

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