BLI-1 INDUSTRIAL TRAINING PLACEMENT CHOICES

This form is to be completed by each prospective intern. A fully completed form

should be submitted to the Industrial Training Coordinator with a copy of
Academic Progress Report.

SECTION A: STUDENT DETAILS

Full Name : _________________________________________________________________________________________

IC / Passport : _________________________________________________________________________________________

Matric Num. :

Programme :
Multimedia Technology (HC12) E-commerce (HC13)
Tel. Num. : _______________________________________
Email : _________________________________________________________________________________________

SECTION B: LIST OF CHOICES

1ST CHOICE
Name of Company : ________________________________________________________________________________________
Type of Company : Government Agency Private Company Multinational Company Others ______________

Address : ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

website _________________________________________________________________________________

What is the core : ________________________________________________________________________________________

business of the ________________________________________________________________________________________

company?
________________________________________________________________________________________
________________________________________________________________________________________

Academic SVs Approval Highly Recommended Recommended Not Recommended

2ND CHOICE
Name of Company : ________________________________________________________________________________________
Type of Company : Government Agency Private Company Multinational Company Others ______________

Address : ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

website _________________________________________________________________________________

What is the core : ________________________________________________________________________________________

business of the ________________________________________________________________________________________

company?
________________________________________________________________________________________
________________________________________________________________________________________

Academic SVs Approval Highly Recommended Recommended Not Recommended

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 BLI-1
RD
3 CHOICE

Name of Company : ________________________________________________________________________________________

Type of Company : Government Agency Private Company Multinational Company Others ______________

Address : ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

website _________________________________________________________________________________

What is the core : ________________________________________________________________________________________

business of the ________________________________________________________________________________________

company?
________________________________________________________________________________________
________________________________________________________________________________________

Academic SVs Approval Highly Recommended Recommended Not Recommended

4TH CHOICE

Name of Company : ________________________________________________________________________________________

Type of Company : Government Agency Private Company Multinational Company Others ______________

Address : ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

website _________________________________________________________________________________

What is the core : ________________________________________________________________________________________

business of the ________________________________________________________________________________________

company?
________________________________________________________________________________________
________________________________________________________________________________________

Academic SVs Approval Highly Recommended Recommended Not Recommended

5TH CHOICE

Name of Company : ________________________________________________________________________________________

Type of Company : Government Agency Private Company Multinational Company Others ______________

Address : ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

website _________________________________________________________________________________

What is the core : ________________________________________________________________________________________

business of the ________________________________________________________________________________________

company?
________________________________________________________________________________________
________________________________________________________________________________________

Academic SVs Approval Highly Recommended Recommended Not Recommended

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 BLI-1
TH
6 CHOICE

Name of Company : ________________________________________________________________________________________

Type of Company : Government Agency Private Company Multinational Company Others ______________

Address : ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

website _________________________________________________________________________________

What is the core : ________________________________________________________________________________________

business of the ________________________________________________________________________________________

company?
________________________________________________________________________________________
________________________________________________________________________________________

Academic SVs Approval Highly Recommended Recommended Not Recommended

7TH CHOICE

Name of Company : ________________________________________________________________________________________

Type of Company : Government Agency Private Company Multinational Company Others ______________

Address : ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

website _________________________________________________________________________________

What is the core : ________________________________________________________________________________________

business of the ________________________________________________________________________________________

company?
________________________________________________________________________________________
________________________________________________________________________________________

Academic SVs Approval Highly Recommended Recommended Not Recommended

8th CHOICE

Name of Company : ________________________________________________________________________________________

Type of Company : Government Agency Private Company Multinational Company Others ______________

Address : ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

website _________________________________________________________________________________

What is the core : ________________________________________________________________________________________

business of the ________________________________________________________________________________________

company?
________________________________________________________________________________________
________________________________________________________________________________________

Academic SVs Approval Highly Recommended Recommended Not Recommended

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 BLI-1
th
9 CHOICE

Name of Company : ________________________________________________________________________________________

Type of Company : Government Agency Private Company Multinational Company Others ______________

Address : ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

website _________________________________________________________________________________

What is the core : ________________________________________________________________________________________

business of the ________________________________________________________________________________________

company?
________________________________________________________________________________________
________________________________________________________________________________________

Academic SVs Approval Highly Recommended Recommended Not Recommended

10th CHOICE
Name of Company : ________________________________________________________________________________________
Type of Company : Government Agency Private Company Multinational Company Others ______________

Address : ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

website _________________________________________________________________________________

What is the core : ________________________________________________________________________________________

business of the ________________________________________________________________________________________

company?
________________________________________________________________________________________
________________________________________________________________________________________

Academic SVs Approval Highly Recommended Recommended Not Recommended

Students Signature, Academic Supervisors Signature,

__________________________ __________________________
Date: Date:

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