Civil Engineering Experience Certificate Programme CEECP

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					 美國土木工程師學會國際學生會                                                                            American Society of Civil Engineers
(香港科技大學土木及環境工程學系)                                                                                 International Student Group,
email:asce@ust.hk
                                                                                                       Department of Civil and
http://ihome.ust.hk/~asce/
                                                                                          Environmental Engineering at HKUST




      Civil Engineering Experience Certificate Programme 2012(CEECP 2012)
                                                     Application Form


 Part I: Personal Information

 Name: (English in BLOCK) ................................ (Chinese) ............................
 HKID Card No.: .............................................. Date of birth: .......................                    Photo
 Nickname: ....................... Gender (M/F): ....... T-shirt size (S/M/L/XL): .........
                                                                                                                          Here
 Correspondence address: .............................................................................
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 Phone(Home): .................... Mobile phone: ............... E-mail: .........................................
 Name of school: ....................................................... Class: ……….… Stream:(Art/Science)
 School address: ..............................................................................................................
 E-mail of your school†: ....................................................................................................
 In case of emergency, contact:
 Name: ............................... Phone: ......................... Relationship: ................................

 Part II: Self Introduction
 Please write, in about 100 words (in either English or Chinese) about yourself, why you would like
 to take part in this programme and what you would expect from this programme.
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 美國土木工程師學會國際學生會                                                                       American Society of Civil Engineers
(香港科技大學土木及環境工程學系)                                                                            International Student Group,
email:asce@ust.hk
                                                                                                  Department of Civil and
http://ihome.ust.hk/~asce/
                                                                                     Environmental Engineering at HKUST




 Part III: Certification (This part is to be completed by your school.)

 This is to certify that ............................................ (name of student in BLOCK LETTERS) is a
 student of our school.




 School chop: ............................................................... Date: .........................................
 Teacher in charge (name): ........................................... Contact number: .........................

 Part IV: Declaration

 I, ................................................. (your full name in BLOCK LETTERS) declare that ASCEISG,
 HKUSTCE and the organizers of this programme are not under any liability for the loss of property
 or injury to me.

 Signature: .................................................................. Date:..........................................

 Part V Consent of Parents/Guardian (This part is required for participants below the age of
 18 and should be filled in by parents or guardian#.)

 I agree to allow ................................................. (participant’s full name in BLOCK LETTERS)
 taking part in the Civil Engineering Experience Certificate Programme 2012 and declaring that
 ASCEISG, HKUSTCE and the organizers of this programme are not under any liability for the loss
 of property or injury to the participants.

 Signature of parent/guardian*: ...................................... Date: .........................................
 Name: ....................................................................... Contact number:..........................
 *
     Delete where inappropriate.
 #
     Parent or guardian should be above the age of 18.
 †
     Successful applicants will be notified in June 2012 and instructions on payment will be given.
 Reminder:
 Application Method
 1.     By post mail
 Please send a completed application form to
                 P.O. Box No. 65269, Tseung Kwan O Post Office, Hong Kong
 (Please state ‘Civil Engineering Experience Certificate Programme 2012’ on the envelope)
 2.     By email
 Please send an email to asce@ust.hk with a completed application form attached
 The deadline of application is 3rd June 2012
 For enquiries, please browse our website: http://ihome.ust.hk/~asce/ceecp or e-mail us:
 asce@ust.hk



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