Application for Taught Postgraduate Studies

Last Name(family name)
This is the name under which your file will be registered and the name you should use on any future correspondence with us.

Title
Please add the title you normally use, eg. Mr, Ms etc.

Forename(s) (given names) in full
Please add all your forename(s) in the order in which they normally appear.

Year of Birth

Gender

Application
Please state the full title of qualification for which you are applying.

Course of Study:

Study Load:
Proposed Date of Admission:

Have you ever been a student at Warwick?

Please enter your university number, if known.

Permanent home address / correspondence address
Your permanent home address. This address will also be used as the address for correspondence.

Postcode:
Contact Telephone:
Mobile:
Fax:

Email

Company Telephone and Fax

Telephone:
Fax:

Nationality

Country of permanent residence
The country in which you have been normally resident, except for periods of tomporary absence.

Country of birth

Are you currently studying at an educational institution?

Please give the information and expected end date of that course.

Name of institution
The course will end on

Qualifications held
Please state the titles of your qualification(s) as it appears on your official transcript & certificates.

1	Name of University / College and Country
	Dates attended (eg 1995 - 1999)
	Degree(s) awarded and class, eg BA(Hons) 2i, GPA
	Degree with date
	Principal subjects taken

2	Name of University / College and Country
	Dates attended (eg 1995 - 1999)
	Degree(s) awarded and class, eg BA(Hons) 2i, GPA
	Degree with date
	Principal subjects taken

3	Name of University / College and Country
	Dates attended (eg 1995 - 1999)
	Degree(s) awarded and class, eg BA(Hons) 2i, GPA
	Degree with date
	Principal subjects taken

4	Name of University / College and Country
	Dates attended (eg 1995 - 1999)
	Degree(s) awarded and class, eg BA(Hons) 2i, GPA
	Degree with date
	Principal subjects taken

5	Name of University / College and Country
	Dates attended (eg 1995 - 1999)
	Degree(s) awarded and class, eg BA(Hons) 2i, GPA
	Degree with date
	Principal subjects taken

English Language Qualifications
Have you been educated in the UK or another English speaking country?

Type of test taken:
Date of test:
The score is:

Career history
Please give your employment history to date or other professional experience excluding vacation work. For present employment, please select 'Now' in the 'To (MMM)' column..

1	Dates from and to	From (MMM-YYYY): - To (MMM-YYYY): -
	Company name
	Position held
	Company address
	Nature of work

2	Dates from and to	From (MMM-YYYY): - To (MMM-YYYY): -
	Company name
	Position held
	Company address
	Nature of work

3	Dates from and to	From (MMM-YYYY): - To (MMM-YYYY): -
	Company name
	Position held
	Company address
	Nature of work

4	Dates from and to	From (MMM-YYYY): - To (MMM-YYYY): -
	Company name
	Position held
	Company address
	Nature of work

5	Dates from and to	From (MMM-YYYY): - To (MMM-YYYY): -
	Company name
	Position held
	Company address
	Nature of work

Total number of year of professional experience accumulated: year(s) / month(s)

Finance
How would you finance yourself at this programme?

Self
Family
Employer
Scholarship

Please give detail of Scholarship

Name of scholarship(s):

Which scholarship(s) have you obtained?

Please state to which other Universities you are applying
We ask for this information for our own records - it does not affect your application to us.

Source of information about this programme

Advertisement
Recommendation from Student
Graduate School Prospectus
Departmental Information
Poster
World Wide Web
Careers Office
British Council
Postgraduate Fair
Employer
Recommendation from Tutor / Academic
Other

Special Needs
The University welcomes applications from people with special needs and considers them on the same academic grounds as those from other candidates. It is helpful to know about your special needs in advance so that we can discuss whether facilities are available in the University. Applicants with special needs are encouraged to contact The IGDS/IMDS Administration Unit, Tel: 2766-6624/25/27/37 or Email: mfigds@polyu.edu.hk.

If you have special needs, please tick the boxes which are applicable to you:
Dyslexia
Blind / partially sighted
Deaf / hearing impairment
Need personal care support
Mental health difficulties
Wheelchair user / mobility difficulties
An unseen special, eg Diabetes, epilepsy, asthma
Other special need

Are you a registered disabled person?

Academic interests and purpose of study (Not applicable for single module's applicants)
Note: all participants must complete this section.
Please use this space to describe your special academic interests and your purpose and objectives in undertaking graduate only.

	I declare that the information given in support of this application is accurate and complete. I understand that any misrepresentation will lead to disqualification of my application for admission to and registration with The Hong Kong Polytechnic University (PolyU). Making, submitting or using any false instrument (including forged documents) are serious criminal offences involving dishonesty under the Crimes Ordinance (Cap. 200, Laws of Hong Kong), punishable by imprisonment. The University will refer any instances of suspected admission fraud matters to the police. The University reserves the right to take other actions.
	I confirm that I read and understood the following relating to my personal data and information.
	for applicant from Mainland China [Personal Information Collection Statement for Applicant from People’s Republic of China] for applicant from EU country [Notice for Application from the European Area] for applicant from Hong Kong or other country/region [Personal Information Collection Statement for Applicants]
Have you engaged an education agent to assist you with your application? Yes No

Word Verification: Captcha Image