Part-time Course Application Form

Course Title: 

Course Code: Commencement Date: 

Name: Employer :

Address:New IC No.: 

Home Tel. No.: Office Tel. No.: Fax No.:

Position Held: Years of Experience: years

Highest Academic Qualification:

Technical or Other Qualifications:

Sponsor (Self-sponsor/Employer):

Payment Mode (P.O./M.O./Cheque):

Note: All payments should be made to: Pengetua, Institut Latihan Perindustrian, Melaka

To cancel click: When completed click: