Wsc.gdut.edu.cn
FACULTY OF CONSTRUCTION AND ENVIRONMENT &
RESEARCH INSTITUTE FOR SUSTAINABLE URBAN DEVELOPMENT
THE HONG KONG POLYTECHNIC UNIVERSITY
Summer School for Outstanding Postgraduate and Senior Undergraduate Students
Application Form
(Application deadline: 1 April 2013, late applications will not be accepted)
Part A Information of the Applicant (Copy of degree certificates, transcript/academic results report should be attached to this application)
Student name: _____________(Surname)________________(Given name)____________(Chinese Name)
Sex: F/M* Nationality: ____________________ TOEFL/IELTS* result (if any): ___________
Current Year of Study: _____ Duration of the Academic Programme: _____________________________
Academic Programme Title: ____________________________________________________________
Latest ranking in class^ (e.g. 3 out of 50 students): _________ Latest GPA/average score*^: _______
Department: __________________________Name of University: _______________________________
Correspondence Address: ________________________________________________________________
Phone: ____________________________ E-mail: ____________________________________________
* please delete as appropriate
^ if the class ranking, GPA/average score of the 2012/13 academic year are not available at the time of application, please provide the required information for the year before
□ I declare that the information given above is correct and complete to the best of my knowledge and belief. I understand that if I give any false information or withhold any relevant information, I shall render myself liable to dismissal of the offer by The Hong Kong Polytechnic University.
□ In connection with my application for the Summer School, I hereby authorize The Hong Kong Polytechnic University to seek additional information from my academic referee(s) upon receipt of my application.
□ I undertake to abide by the regulations of The Hong Kong Polytechnic University.
|Signature | | |Date | |
Part B Academic Referee(s) (if you have more than one referee, please complete this part in a separate form.)
Name of Referee: _________________________________ Post: ________________________________
Department: __________________________Name of University: _______________________________
Phone: ____________________________ E-mail: ____________________________________________
I am pleased to confirm/can’t confirm* that the class ranking and GPA/average score provided above by the student are correct. I would like to recommend _______________(student’s name) for the Summer School with the following reasons (please use separate sheet if necessary):
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