HONG KONG BAPTIST UNIVERSITY by tyndale

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									                                    HONG KONG BAPTIST UNIVERSITY
                                           Academic Registry                                                 URGENT
                                           Admissions Section

                               2006 JUPAS Admissions Exercise (July Interview)

                               Request Form for Change of Interview Date/Time

To:          Mr. Ben Fok / Ms. Helen Chan / Ms. Cherry Chan
Fax:         3411 7373                             E-mail:                      arjoint@hkbu.edu.hk
From:        (Name)

             (JUPAS Application No.)
Contact:     (Mobile)

             (E-mail Address)
             (Applicant will be notified of the result of this request by mobile phone or via e-mail.)

I would like to request for a change of the scheduled interview date/time due to special circumstances
beyond my control, e.g. accident, illness. I understand that this request may be approved or not and I
will accept the decision made by the Academic Registry and the respective department in this regard.
The details of my request are as follows:

 Course for interview:         Course                                     Course
                               Code                                       Title


                                                                                 REQUEST FOR A CHANGE TO
                                         ORIGINAL                         ●      Requested date and time are considered on an
                                                                                 individual basis.
         Interview Date:

         Interview Time:


Reasons for change of interview date/time:




Supporting documents attached:               ___      No          ___         Yes          No. of pages attached =

Signature:                                                        Date:

For Office Use
(i) Department’s Consideration (to be replied                     (ii) Applicant to be notified of the decision by
    * on / before: ____________________ )                              * Department / Academic Registry via
                                                                       e-mail / phone.
   Request is       __ approved __ not approved.

   By:                           Date:                              By:                             Date:
           (name in capital)                                                  (name in capital)


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