Admission of Subject-Based Students



Admission of Subject-Based StudentsPlease read the notes for applicants before completing this form. To be completed by applicant (in English and in BLOCK LETTERS) Name in English :455168010096500139827010096500(as shown on HKID Name in Chinese:card/Passport/Mainland ID card)415226599060If you are a non-local applicant,please check the box (see note 1 overleaf)00If you are a non-local applicant,please check the box (see note 1 overleaf)13792205588000HKID/Passport/ FORMCHECKBOX Mainland ID No.:4319600138430Male (M) /Female (F)00Male (M) /Female (F)139255513652500Date of Birth: Sex : (e.g. 31 JAN 1990) 139255510795000Nationality:13950952222500 Correspondence Address:139509511366500 Residential Address:1395095469900044259505588000 Home Telephone No.: Mobile No.:14052558509000 Email Address: The Highest Education Level Attained: FORMCHECKBOX Secondary School FORMCHECKBOX Sub-degree FORMCHECKBOX Undergraduate FORMCHECKBOX Taught Postgraduate (Please check the box) Work Experience:From(MMM/YYYY)To(MMM/YYYY) Full-time/Part-TimeField of EmploymentName of OrganizationJob PositionChoose an item.Choose an item.3379470698500022307556985000 Total Years of Full Time Work Experience: Year(s) Month(s) EMERGENCY CONTACT INFORMATION107632511366500 Contact Person: 10845807683500 Contact Phone:10902958636000 Contact Address:108775510160000 Email Address:If you are a current PolyU student, please state your current student no. and the programme you are attending: _______________________________________________________________________________________________________If you are a PolyU alumnus, please state your student no. and the programme(s) you had taken:_______________________________________________________________________________________________________Subjects intended to enrollSubject TitleSubject CodeSemester(please tick as appropriate)To be input by subject offering dept.For approved cases, student to attend the following subject group (to facilitate fee calculation and subject registration)12SummerGroup No.Fee per creditIII.Authorization and declaration of applicantI authorize The Hong Kong Polytechnic University to use my data provided above for the following purposes:-as a basis for processing my application for admission as subject-based student;for transferring to the student record system upon enrolment. The data together with my photo image collected at the time of registration will be used in activities and services provided by units of the University in support of my study at the University; for facilitating communications between me and PolyU; andfor conducting statistical analysis, research, surveys, quality assurance and review.I confirm that I have read and understood the "Personal Information Collection Statement (PICS)" of PolyU. IV Consent for Receiving Promotional InformationUse of Personal Data in Direct MarketingThe Hong Kong Polytechnic University ("PolyU") would like to advise you from time to time the activities and services which may enrich your study and student life but are not compulsory as part of your study. When you leave PolyU, we would also like to maintain contact with you to update you on the latest developments of PolyU and benefits, activities and services available to you. In doing so, PolyU may use [your name, address, telephone number, fax number and email address] for the purposes of offering to you or providing to you the availability of the following activities, services and facilities (collectively, "marketing subjects"):Co-curricular activities, student exchange programmes, placement opportunities, invitation for research participation and competitions, programmes, courses, seminars, workshops, conferences and events organized by PolyU alone, jointly with other parties or by other parties;Scholarships, grants, loans and financial assistance scheme;Privileges, discounts and offers for services, goods and other facilities provided by PolyU alone, jointly with other parties or by other parties;Services offered by PolyU (e.g. University Health Services, Optometry Clinic, etc.);Charitable, educational, social and other activities that solicit contributions, donations or participation.PolyU cannot use your personal data for sending information on the above marketing subjects to you unless we have received your consent or indication of no objection. Please sign at the end of this page to indicate your agreement for PolyU to use your personal data to send you information on the above marketing subjects. If you do not wish to receive the information, please tick the box below before you sign at the end of this page: FORMCHECKBOX ?I do not agree PolyU to use my personal data to send me marketing information indicated above.(You may make subsequent changes on your choice of receiving further information on the marketing information anytime on the Personal Details page of the eStudent.)Signature of applicant Date FOR OFFICE USEV.Decision of Department(Please forward the completed application form to the Academic Secretariat for follow-up for approved cases only) Application is *approved/rejected.Approval from Faculty Deans has been sought due to total enrolment per class exceeding the maximum limit of 25%.Informed applicant of the decision and subject(s) to be accepted onbyA copy of applicant’s HKID card/Passport/Mainland ID card, and a recent colour photograph (photograph size: 40mm(W) × 50mm(H)) or JPG image file (image size: 1200 pixel(W) × 1600 pixel(H))Alumni Sponsorship is offered to the student. Signature Date Faculty/Departmental Enrolment Liaison Officer*delete as appropriateVI. Action taken by the Academic Secretariat Application form received on, with photograph attached/not attached. For current student, copied to the department concerned, where appropriate. Student record updated on by Notice of offer sent to student on by (8 May 2017)Notes for Applicants Completion of formApplicants should complete Sections I to IV of the form. Non-local students are people who require student visas/permit issued by the Hong Kong Immigration Department to enter Hong Kong for the purpose of education.? Spouses and dependent children up to 18 years old of non-local people who are permitted to work in Hong Kong by the Immigration Department and hold dependent visas are not considered to be non-local students. In the case of non-local applicants who possess only a visitor or a tourist visa, we can neither register them as a student nor allow them to commence study until a student visa is obtained. Completed form together with a photocopy of your HKID card/Passport/Mainland ID card (it will be destroyed after the printing of Student Identity Card), and a recent colour photograph (photograph size: 40mm(W) × 50mm(H)) or JPG image file (image size: 1200 pixel(W) × 1600 pixel(H)) should be submitted to the Department offering the subject(s). In cases where the subjects intending to enrol are offered by two different departments, the application form should be returned to the Academic Secretariat, 1/F., Li Ka Shing Tower of PolyU.For those applicants who wish to enrol on two or more subjects concurrently, and are also currently enrolled on programmes offered by PolyU or any other institutions, they are advised to seek advice from the current department concerned before submitting an application for subject-based enrolment. They should also note that the University is not responsible for making alternative arrangement for clashes in class and examination timetables.Notification of application resultsThe department hosting the subject will inform the applicant of the result of their application and the class timetable and/or assessment arrangements.Successful applicants will receive a written notification from the Academic Secretariat inviting them to settle the requisite fee and collect the student identity card within 2 weeks after the receipt of the application.Fee refund policiesExcept for subject cancellation, subject fees paid are neither refundable nor transferable. Caution money will be charged upon admission. It will be refunded at the end of the semester subject to no outstanding items with the University.Student identity cardStudents will be issued a Student Card and they may use this card to access to the University Library and Student Computing Centre. Rights to use any facilities of the University are given at the discretion of the University.CertificationHaving satisfied all the prescribed requirements for subject completion, student will be issued an official assessment result notification at the end of the semester and can apply for a transcript of studies on a paid basis. Further admissionAdmission of subject-based students will be processed on a semester basis and students need to re-apply for admission if they wish to enroll on subjects in other semesters.Subject-based students are required to follow the normal application procedures and observe the prevailing entrance requirements prescribed for the programme and the credit transfer policy, if they later wish to seek admission to PolyU programmes leading to formal awards.Use of information Personal data provided in this application will be used solely for the purpose of this admission, and in this connection the data will be handled by the Academic Secretariat and other relevant departments in support of the applicant’s study at PolyU.Under the provisions of the Personal Data (Privacy) Ordinance, applicants have rights to request access to, and the correction of, their personal data. Applicants wishing to access or make corrections to their data should submit written requests to the Academic Secretariat. ................
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