APPLICATION FORM
LAX 2051 NEW PLACES NEW
INSIGHTS ENROLMENT APPLICATION FORM
Programme Information
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Title:
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Organiser:
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Objectives:
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Duration:
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_________ weeks from ___________________ until ________________
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Destination:
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Status:
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Mobility
Internship
Training |
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Supervisor/Advisor:
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Name:
Designation:
Tel. no: Email:
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Appointed LAX
Supervisor:
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Name:
Designation:
Tel. no: Email:
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Prepared by:
____________________________________________________________________
Designation:
____________________________________________________________________
Tel. & email
add..: ____________________________________________________________________
Official stamp:
*This form must be submitted to CALC office together with the
programme itinerary at least 2 weeks prior to the programme commencement date.
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OFFICE
USE
Date received: _________________________________________
Application status: Approved Rejected (reason )
_________________________________
________________________________________________
Name:
Designation: ___________________________________________
Tel. & email
add..: ________________________________________
Official stamp:
List of Students Involved
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No
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Name
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Matric No
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Faculty
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Contact Information
(mobile & email
address)
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