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University-Industry Collaboration Form
This form is from the Faculty of Chemical and Energy Engineering, Universiti Teknologi Malaysia. The purpose of this survey is to gather potential university-industry collaboration opportunity with industries.
* Indicates required question
Email
*
Record my email address with my response
Company/Agency/Institute Name
*
Your answer
Company Address
*
Your answer
Name of Company Representative
*
Your answer
Position
*
Your answer
Contact info (Phone number, email, etc.)
*
Your answer
Company website
Your answer
Select what your company may be interested to collaborate with University
*
UNIX (Undergraduate Research Project + Internship - 1 year programme)
Research Project (Double tax deduction oppurtunity)
Consultancy
Industrial Internship Student (Undergraduate)
Lab services
Satellite Lab
Other:
Select the next action to start the collaboration:
*
We would like to request further presentation to our top management from the industry.
We do not need further presentation with the top management, but would like to discuss the details
Other:
Field of interest
*
Chemical Engineering
Chemical-Bioprocess Engineering
Chemical-Gas Engineering
Petroleum Engineering
Nuclear Engineering
Other:
Potential topic projectÂ
Your answer
Thank you
A copy of your responses will be emailed to .
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