全国高考

THE UNIVERSITY OF HONG KONG

Mainland Exchange Student

APPLICATION FOR ADMISSION

Please refer to the “Guidelines for completing exchange application” before completing this form. The application form should be completed in English unless specify. 1. PERSONAL INFORMATION

Mr/Mrs/Miss/Ms* (full name in English block letters) :

Name in Chinese characters :

Date and place of birth :

Affix Photo

(3cm x 4cm)

Address for correspondence (both in Chinese and in English block letter): Telephone (Home / Mobile):

Fax : E-mail address :

Permanent home address (both in Chinese and in English block letter) : 2.

EDUCATION

Give details of your previous education so far as it is relevant to your application for admission as a Mainland Exchange Student. (Certified true copies of certificates and transcripts must be attached to this application.)

Year Name of the Examination (e.g. 全國高考 / TOFEL) Subject Total Score (e.g. Science / Art / (please state the full mark of Combined / English ) the Examination inside the bracket) ( ) ( ) ( ) ( ) ( ) ( ) ( )

CURRENT STUDIES (Please attach officially certified transcripts # with complete record on the courses attended and examinations results.)

Institution:

Title of degree :

Present year of studies:

Expected date of completion of studies:

3. EXTRA-CURRICULAR ACTIVITIES AND PRIZES, MEDALS AND OTHER AWARDS

Please write briefly about your extra-curricular activities, positions held, and voluntary services; and prizes/medals and other awards you have won in the past years.

4. 5.

ADMISSION

Desired enrollment period : ______ / ______ / ______ (date / month / year)

to

______ / ______ / ______

PROPOSED STUDY AT THE UNIVERSITY OF HONG KONG (Please refer to N3 of Guidelines)

a. Undergraduate courses (Before completing this section, please study the regulations and syllabuses for the relevant

curriculum. Regulations and course descriptions are available at website \"www.hku.hk/student/uregcourse\".) State the faculty to which you wish to be admitted as a Mainland exchange student :

List below the courses you wish to take: Course code Course title To be completed by head of department at HKU accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* accept / reject* Signature

# Photocopies of documents 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 the 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. Special arrangements on examinations will not be made unless under extreme circumstances.) Reason(s) for such an application:

# #

To seek credit 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. # * 7.

Approved / Not approved* Approved / Not approved* Approved / Not approved* Approved / Not approved* Approved / Not approved* Approved / Not approved* Approved / Not approved* Approved / Not approved* Approved / Not approved* Approved / Not approved* Department Department Department Department Department Department Department Department Department Department Signature Signature Signature Signature Signature Signature Signature Signature Signature Signature Tick as appropriate Delete as appropriate

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 credit towards the applicant’s present degree course. Name and position :

Name of institution : Date :

Please affix official seal or stamp

Signature:

8. SUPPORTING DOCUMENTS I attach the following documents in support of my application: # Academic transcripts / Certificates # TOEFL results / other proof of English proficiency # My curriculum vitae # Other supporting documents, please specify:

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.

2. I authorize The University of Hong Kong to use, check and process my data as required for my application. 3. 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 this University.

4. I declare that the information given in support of this application is accurate and complete. I understand that any

misrepresentation will disqualify my application.

Date :

Signature :

# Tick as appropriate

* Photocopies of documents not properly certified will NOT be accepted.

February 2006