INTERNATIONAL VISIT REQUEST FORM

INSTRUCTIONS

Complete the form below for the requests to visit

Universiti Sains Malaysia. All applications for an official
visit to USM must be submitted 30 days in advance of
the proposed visit date or may not be considered.

Please submit the completed application form to:

SECTION 1: ORGANISATION DETAILS

If requesting a visit on behalf of another organization please provide full details of the visiting organization.
Organisation Name : Ajou University
Street Address : Worldcup-ro 206, Yeongtong-gu
City : Suwon

State/Province/Region

Postal/Zip Code : 16499

Country : South Korea

Phone : +82-10-9270-8389

Fax

Website : http://test.ajou.ac.kr/en/

Section 2: VISIT DETAILS

Proposed Date 17/Aug/2016

Time 10:00 (1hour ~ 1 hr 30min) AM

Visit Objective and Areas of Interest for Discussion. (Please list in order to priority)
1.

To understand education system, facilities, infrastructures of higher education in Malaysia, by visiting partner university

2.

General Introduction on USM

3.

Campus Tour

4.

Sharing ideas on Lifelong Education in Malaysia

Faculties, Centres and/or facilities you would like to visit. (Please select all that apply)
School of Arts

Management

Dentistry

Graduate School
of Business

Engineering

Business

School of
Communication

School of
Humanities

Social
Sciences

Health Science

Others: International
Office________

Industrial Technology

Languages,
Literacies &
Translation

Education Studies

Housing, Building&
Planning

School of Distance
Education

Medicine

Key people or academic areas you would like to visit. (Please provide details in order of priority)
1.

2.

3.

4.

5.

6.

Have you visited USM in the past?

Yes

Does this delegation include any USM alumni?

v No

Yes

No

Name(s)
Which areas are of greatest interest?

Education

Have you contacted another USM representative with regards to this visit? If so, please specify all contacts and departments/units.
No

Additional requests (e.g. Invitation letters for visa purposes, disabled access, transport advice) : No needed
We will do our best to accommodate these requests but this cannot be guaranteed.
Please specify dietary requirements if applicable.

SECTION 3: DELEGATION DETAILS

Delegation Leader Please provide details of the delegation leader for the visit.
Title

First name : Do-Keun

Family name : Jeon

Position : Professor

Division/Department

E-mail : bangkok3@naver.com

Phone : +82-10-6232-9800
(If applicable please provide contact number in Malaysia)

Delegation Members Please provide details of delegation members attending the visit.
(Attach separate sheet if more than 10 visitors)
Title

First Name

Family Name

Position

Division/Department

1
2
3
4
5
6
7
8
9
10

Laptop

Projector
SECTION 4: REQUEST

Exhibition place

Others: ______

Supplementary Information Checklist:

To complete your request, please ensure the following are attached upon submission:

Biography information on Delegation Leader or significant delegation members.

Background information on institution/organisation and/or other relevant information.

Please e-mail the completed form as an attachment to n.afiqah@usm.my

The office of the PVC International will endeavor to respond to your request within 3 working days.

Delegation leader will be advised when a visit has been approved and further information may be requested.

It is the responsibility of the delegation to provide their own interpreter it required.

Contact:
USM International Mobility & Career Centre,
Building C09,
Universiti Sains Malaysia,
11800 USM, Penang, Malaysia.

Tel:

+604-653-2777/2778/2773/3907

Fax: +604-653-2781
Web: www.usm.my/IO