Student Details
Student ID
*
First name
*
Last name
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Phone (Between Hours)
*
Phone (After Hours)
E-mail
*
Degree
*
Major
*
Please Select
Marketing
Accounting
Human Resources Management
Information Technology
Business Administration
Law
Study Mode
*
Full-time
Part-time
Year of Study
*
1st
2nd
3rd
Unit
*
BIPX100
BIPX301
BIPX302
Semester of Enrolment
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1
2
Year of Enrolment
*
Organisation Details
Organisation Name
*
Website
Non-profit
*
Yes
No
Postal Address
*
Contact Title
*
Please Select
Mr
Mrs
Ms
Dr
Prof
Fr
Sr
Rev
Contact Full Name
*
Contact Position
*
Contact Telephone Number
Contact Email Address
*
Placement Details
Aproximate Start Date
*
Approximate End Date
*
Final Report Due Date
*
Placement Area
*
Please Select
Community Engagement Service (BIPX100)
Marketing
Accounting
Human Resources Management
Finance
Information Technology
Total Hours
*
Attendance Pattern
*
Placement Activities
*
Interview Questionnaire Rating (BIPX301 and BIPX302 students ONLY) from Poor (1) to Excellent (5)
1
2
3
4
5
Scan of Original Placement Agreement
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of
Scan of Original Interview Questionnaire (BIPX301 and BIPX302 students ONLY)
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*
By checking this box, you agree that you will undertake to carry out the above duties, if approved by the University, in a professional manner. You will maintain strict confidentiality of all information pertaining to the organisation and those clients with whom you come in contact. You will notify your Placement Supervisor and the Lecturer-in-charge of any circumstance that affects your attendance or placement immediately, by telephone and in writing.
*
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By checking this box, you certify that both you and the Placement Supervisor has agreed to all the terms and conditions above and signed the Placement
*
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