SRC Executives Nomination Form

1 Nominee Information

Provide the candidate's basic personal information.

First Name *

Last Name *

Other Names

Gender *

Date of Birth

Student ID / Index Number *

2 Academic Information

Provide the nominee's academic details.

Programme / Course *

Level / Year *

Department

Class / Group

3 Nomination Details

Select the position for which the candidate is being nominated.

Position Nominated For *

Why are you interested in this position?

Leadership / Relevant Experience

4 Contact Information

Provide valid contact details for communication.

Phone Number *

Email Address *

Residential / Digital Address

5 Photo Upload

Upload a recent passport-style photograph.

Upload Photo Click to select a JPG, PNG or WEBP image Max: 5MB

6 Declaration

Please confirm the information provided.

I hereby confirm that the information provided in this nomination form is accurate and complete to the best of my knowledge. I understand that the information may be used for the SRC nomination and selection process. *