M.206/108 THE UNIVERSITY OF HONG KONG LI KA SHING FACULTY OF MEDICINE
Master of Research in Medicine (MRes[Med])
Application for Admission 2008-2009
This form should be completed and returned to the Medical Faculty Office, 6/F William M.W. Mong Block, 21 Sassoon Road, Pokfulam by May 31, 2008. You should provide all the information required in this section. If you are admitted to the MRes[Med] programme, this form will be filed for reference. It will be accessible only to those responsible for processing your application, or for administrative and academic aspects of your candidature. Under the Personal Data (Privacy) Ordinance, you have full access and right of correction to Section A of this form, which you may exercise by notifying the Secretary of the Medical Faculty. If your application is unsuccessful, this form will be destroyed.
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Section A
[To be completed by the applicant after prior consultation with the Supervisor(s) concerned]
Personal Information
Mr
Surname: Name in Chinese:
Miss
Ms
Mrs
Given names:
HKU No. (if applicable): Correspondence Address:
Telephone: Email address:
Mobile:
Currently enrolled as an MBBS II / MBBS III * student
*
delete where applicable (For MBBS II students, only holders of a BSc degree with Honours can apply.) 1
Reason for interest in the MRes[Med] Programme
Previous Programme(s) of Study at the University
Applicants who previously studied at The University of Hong Kong must complete this section. Please indicate: (a) whether you have been de-registered by the University due to outstanding fee payment (outstanding fees must be settled before an offer of admission would be made.) (b) whether you were discontinued from studies by the University (by regulation, you shall not be readmitted to the same programme of study. This will not however affect your chance of admission to other programmes.) Yes No
Yes
No
If the answer to (a) or (b) is yes, please specify the curriculum and year of study: (Note: Failure to provide such information may lead to disqualification even after admission.)
Date:
Signature of Applicant:
2
Section B
Details of the proposed research programme.
3
Section C
[To be completed by the Supervisor(s) and Head(s) of Department(s)]
We endorse this application and confirm that the resources of our Department are sufficient to provide the necessary teaching without supplementation. The study plan detailed in Section B is appropriate.
Principal Supervisor
Name: Signature:
Department:
Date:
Co-supervisor
Name: Signature:
Department:
Date:
Head of the Principal Supervisor's Department
Name: Signature:
Department:
Date:
Head of the Co-supervisor's Department
Name: Signature:
Department:
Date:
January 15, 2008
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