Plea complete this application form clearly and accurately in BLOCK letters using a black ballpoint pen . The completed form should be returned to the School of Graduate Studies, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong. Plea also refer to the ction “U of Application Information” in the Admissions Handbook for details on the specific u of the information collected in this form.
A. Personal Particulars
English Name:小鸡破壳而出
胶粉聚苯颗粒Surname:
Given Name:
Chine Name: Gender:
‘M’ – Male ‘F’ – Female
Chine Character Code:
HKID No.:
-
( ) Passport No.: (only if you are NOT
holding an HKID card)
Day Month Year
Date of Birth:
N ationality:
Status:
‘L’ – Local
‘NL’ – Non-local (“Non-local students” are defined as persons entering Hong Kong for the purpo of education with a student visa/entry permit.)
If you are a local applicant, plea identify which one of the following categories you belong to. (Plea tick “√” the appropriate box)
F Holder of a Hong Kong Permanent Identity Card
F Have the right to land in Hong Kong (i.e. with a letter “R” printed above the line of the Date of Issue in the “Hong Kong Identity Card”) F Holder of a One-way Permit for entry to Hong Kong
F Holder of a valid employment visa. Plea specify: Visa Number:____________________________________ Expiry Date:____________________
F Holder of other types of visa that will allow you to study in Hong Kong without a student visa/entry permit. e.g dependant visa, entry visa, entry permit for
quality migrants or capital investment entrants. Plea specify:
Visa Type: ________________________________ Visa Number:____________________________________ Expiry Date:____________________
B. Contact Information
Correspondence
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Address: City: Country:
Country Code Area Code Telephone No.
Contact Phone No.: -
-
Email Address:
C. Propod Candidature and Other Application Details (Plea tick “√” the appropriate box)
Source of Funding: Government funded
(eligible to apply for financial awards and required to pay tuition fees at a rate t by the government) Self-financing
(not eligible to apply for financial awards and required to pay a higher level of tuition fees.) (Plea refer to the ction “Government-funded and Self-financing Rearch Students”.)
Programme Applied For:
MPhil PhD Mode of Study: Full-time Part-time
Department/School:
Propod Rearch Area:
(Plea make reference to the ction “Rearch Areas for MPhil/PhD Programmes”)
Are you a CityU graduate/student? No
Yes If yes, plea provide your student no.:
Have you applied for a CityU MPhil/PhD programme before? No Yes
If yes, in which Department/School: Application for Admission to MPhil/PhD Programmes
D. Undergraduate/Postgraduate Academic Qualifications
Part I. Qualifications Obtained (in rever chronological order)
Month/Year
Academic Institution
From To
Title of Award (Plea specify field of study) Classification of Award/GPA
Country Name
Month/Year
of Award
Language of Teaching of the Institution
Part II. Current Studies (Plea complete this ction if you are currently enrolled in a programme.)
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Start Date
Title of Programme
Country Name
Expected Month/Year of Award
Language of Teaching of the Institution
E. Professional Qualifications Obtained (in rever chronological order)
Name of Awarding Institution (Country)
Professional Qualification
(Plea state types of membership/means of attainment
< by examination, by election, etc.)
Year of Award
F. Working Experience (in rever chronological order)
Month/Year
From To Full-time/
Part-time
Name of Organization
Post
Duties
G. Results of International English Language Tests Taken, if Applicable
Date of Test
Name of Test歌词吧
Score
Month Year
H. Additional Information (Plea tick “√” the appropriate box)
1. Are you a member of CityU staff? No Yes If yes, plea complete the following:
Department: Post: Full-time
Part-time
2. Name of CityU academic staff member contacted, if any:
I. List of Publications
1. Plea list your publication record clearly with the details specified and write down the number of publications in the space provided. If
you need to u parate sheets to provide the details, plea follow the same format as given below.
2.Plea attach the front page of the papers (for papers that have been published) or the letter of acceptance (for papers that have been accepted
for publication) in support of your publication record.
3. *(For applicants to the Faculty of Science and Engineering only) – applicants are requested to indicate whether their journal article(s)
are listed under the SCI - Science Citation Index.If so, applicants should also indicate (a) the category the journal falls under (e.g.
materials engineering) and (b) the ranking of the journal in the said category (e.g. 2 out of 15).
Name of Author(s) Title of Publication Name
of
Journal/Publisher/
Conference
Published/
Accepted for
Publication
Month/Year
(to be)
Published
*SCI
Listed
(Yes/No/
NA)
Book Chapters (Total no.: ) Journal Articles (Total no.: ) Conference Papers (Total no.: ) Others (Total no.: )
J. Academic Referees
Plea give names and contact address of two persons who have connted to act as your academic referees. Plea note that the propod supervisor and persons from non-academic circles are normally not acceptable as referees.
Name Position Name and Address of Institution
1.
2.
K. Declaration
1.I declare that the information t out in this application or any attachments is, to the best of my knowledge, accurate and complete; and
agree to provide the original certificate or official certification for verification of my qualifications (including CityU qualifications) upon request by the University. I understand that this information will be ud in the admission decision process. I accept that if, in reading and completing this application, I knowingly or carelessly provided untrue or incomplete information, any offer of admission, whether accepted or not, may be withdrawn by the University and/or I may be required to
withdraw from any programme which I am enrolled in and all fees paid will not be refunded.
2.I authorize the University to obtain, and the relevant examination authority, asssment body or academic institution in Hong Kong and
elwhere to relea, information about my public examination results, records of studies or professional qualifications if deemed appropriate.
3.I authorize the University to check, and the relevant parties to relea, my employment records if deemed appropriate.
4.I authorize the University to u my data to carry out checks of my application and any records of my studies in the University and
other institutions in Hong Kong and elwhere if deemed appropriate.
5.I understand that, upon my enrolment in a programme, relevant data will become part of my student record and may be ud for
purpos in accordance with the procedures of the University.
Signature: _______________________________________ Date: ________________________________
Important Notes
Documents to be submitted together with the application form:
(1) Application fee receipt or a bankdraft (applications will not be procesd if the payment of the application fee has not been ttled);
and
(2) Two photocopies of the following documents:
(a) A rearch proposal with clear objectives and methodology.
(b)Official certificates and transcripts of academic qualifications (Certificates and transcripts that are not in English should be
accompanied by a formal certified translation in English). [Applicants who obtained degrees from inst
itutions that gave degree classification and/or grade point average but are not shown in the certificate or transcript are required to also nd copies of any other official documents that indicate their formal degree classification or grade point average.]
(c)Certificates of professional qualifications, if applicable.
(d)(In support of your publication record, if applicable) The front page of the papers (for papers that have been published) or the letter of
acceptance (for papers that have been accepted for publication). [Applicants to the School of Law must also submit a lf-asssment (of not more than 400 words) of their publications together with full copies of their best three publications. Where any publication so submitted is in a language other than English, it must be accompanied by an abstract in English.]
(e)Results of international English language tests, if applicable.冬菇
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Referee’s Report
Plea nd the referee’s report form to two academic referees for completion. Completed forms should be returned by the referees to the School of Graduate Studies directly under confidential cov
er.
L. Survey of Source of Information
Plea tick “√” the appropriate box to indicate the main channel through which you came to know about CityU’s rearch degree programmes. The information sought below does not form part of your application. Thank you for your help.
Newspaper (Title: _____________________________)
Internet I am a CityU student/graduate Local/Overas (Plea delete as appropriate)
Through student/staff at CityU Exhibition/Fair (Title: ______________________)
Other sources: _________________________________米开朗基罗传
