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Application form for Exchange Students

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					1/104 (Amended)

THE UNIVERSITY OF HONG KONG
Exchange Student
APPLICATION FOR ADMISSION (Faculty-level exchange)
Please refer to the “Guidelines for completing exchange application” before completing this form. 1. PERSONAL INFORMATION

Affix Photo (3cm x 4cm)

Mr/Mrs/Miss/Ms* (full name in English block letters as stated in your passport): (family name) (first name) (middle name)

Name in Chinese characters (if any):

Date and place of birth: Present nationality: Address for correspondence: Sex:

Telephone: Permanent home address:

Fax:

E-mail address:

Address in Hong Kong (if any and if different from above):

2.

EDUCATION Give details of your previous education so far as it is relevant to your application for admission as an Exchange Student. (Certified true copies of certificates and transcripts must be attached to this application. Documents that are not in English must be accompanied by a certified translation in English.) Duration of study (state F/T or P/T & no. of years) Major subject Honours classification Awarding institution (state country) Date of award

Title of degree/diploma /certificate courses

* Delete as appropriate

3.

CURRENT STUDIES (Please attach officially certified transcripts# with complete record on the courses attended and examinations results. Transcripts which are not in English should be accompanied by a certified translation in English.) Home Institution (state country): Title of degree / diploma: Major: By research or coursework: Expected date of completion of studies: Minor or double major: Present year of studies:

4.

ADMISSION AT HKU Desired enrollment period: (date / month / year) ______ / ______ / ______ to ______ / ______ / ______

5.

PROPOSED STUDY AT HKU (Please refer to N3 of Guidelines) a. Undergraduate courses (Before completing this section, please study the regulations and syllabuses for the relevant curriculum in which you wish to enrol. Regulations and course descriptions are available at website "www.hku.hk/student/uregcourse".) State the faculty and curriculum to which you wish to be admitted as an exchange student:

List below the courses you wish to take: To be completed by head of department at HKU Course code Course title accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* b. Research (only applicable to postgraduate students) State the department in which you wish to undertake your research: Signature

Identify the facilities required to undertake the research (including equipment, space, resources, etc.):

Please attach a summary of proposed research. # Photocopies of documents which are not properly certified will NOT be accepted. * Delete as appropriate

6.

COURSEWORK, EXAMINATIONS AND CLASS TESTS (Please refer to N4 of Guidelines) (Please complete this section if you wish to apply for permission to participate in the coursework and sit examinations and class tests of the proposed courses of study. Please note that once such application is approved, you are required to fulfil the same requirements specified in the regulations or syllabuses as for regular students of the University. Special arrangements on examinations will not be made unless under extreme circumstances.)

Reason(s) for such an application: # To seek credits for the work done in this University towards the degree course in your home institution. (Section 7 of this form should be completed by the Registrar or Dean of your home institution) For other reason(s) (Please use separate sheet)

#

TO BE COMPLETED BY HEAD OF DEPARTMENT AT HKU

Application for permission to participate in coursework and to sit examinations/tests of the proposed courses of study as listed in Section 5a.

Approved / Not approved* Approved / Not approved* Approved / Not approved* Approved / Not approved*

Department Department Department Department

Signature Signature Signature Signature

# *

Tick as appropriate Delete as appropriate

7.

CERTIFICATE BY HOME INSTITUTION (Please refer to N5 of Guidelines) (To be completed by the Registrar or Dean of the applicant’s home institution before the application is submitted.)

I certify that this applicant is a student registered in the curriculum for the degree of _____________________________________ at this institution, and that the courses listed in Section 5 above would be acceptable to this institution for the purposes of transferring credits towards the applicant’s present degree course.

Date:

Signature:

Name and position:

Name of institution: Please affix official seal or stamp

8.

SUPPORTING DOCUMENTS I attach the following documents in support of my application:

# # # # #

Academic transcripts / Certificates A summary of proposed research (if applicable) TOEFL results / other proof of English proficiency My curriculum vitae (optional) Other supporting documents, please specify:

I have asked the following institution(s) to send academic transcripts direct to The University of Hong Kong:

9.

DECLARATION 1. I understand that my participation in the exchange programme is conditional upon my application being reviewed and approved by The University of Hong Kong and the home institution. I have noted the general points pursuant to the Personal Data (Privacy) Ordinance (Annex I). I authorize The University of Hong Kong to use, check and process my data as required for my application. I understand that upon successful application, my data will become a part of my personal record and may be used for all purposes as prescribed under relevant rules and regulations as well as attendant procedures, so long as I remain student of the University. I declare that the information given in support of this application is accurate and complete. misrepresentation will disqualify my application. I understand that any

2. 3. 4.

5.

Date:

Signature:

# *

Tick as appropriate Photocopies of documents not properly certified will NOT be accepted.

January 2004
FK/ah/app-exch.doc

Annex I 12/602

THE UNIVERSITY OF HONG KONG
Personal Information Collection Statement
This is a statement to inform you of your rights under the Personal Data (Privacy) Ordinance. 2. Personal information is provided by you as an applicant through the completion of application forms designated for various purposes, e.g. for admission to a programme of study, for an exchange programme, for hall admissions, and for provision of facilities or services. Data collected are used specifically for the purposes prescribed in the application forms and will serve a) b) as a basis for selection of applicants; as evidence for verification of the applicant’s examination results, academic records and other information; and where applicable, as part of the applicant’s official student records.

c)

In the case of (c) above, information so incorporated into student files will be used for all purposes relating to the student’s studies as required by the relevant regulations and procedures of the University. 3. Personal data will be kept confidential and handled by the University’s staff members. The University may transfer some of the data to an agent or other persons appointed to undertake some of its academic and administrative functions. 4. Under the provisions of the Ordinance, you have the right to request the University to ascertain whether it holds your personal data, to be given a copy, and to apply for correction of the data, if deemed incorrect. 5. Applications for access to and correction of personal data should be made by using a special request form, and on payment of a fee in the case of data access requests. Such applications as well as requests for information should be addressed to the Data Protection Officer, Registry, The University of Hong Kong.

H.W.K. Wai Registrar
HWKW/RT/ml(m5156/W80)


				
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