/ THE HONG KONG
UNIVERSITY OF SCIENCE
AND TECHNOLOGY / / OFFICE OF POSTGRADUATE STUDIES

Summer Camp 2016

Application Form

Part 1 Personal Particulars

Name in English
(Must be identical to the one used in identity documents) / Family Name / Given Names
Date of Birth(dd/mm/yyyy) / Place of Birth(Country) / Gender
Travel Document
(if applicable) / Passport No. / Issuing Country
Citizenship
Home Address
Mailing Address
(if different from above)
Contact Information
(Please include both country code and area code) / Mobile Phone No. / Other Contact Phone No., if applicable
Email Address
Emergency Contact / Name in English / Relationship
Phone No. / Email Address
Contact Address

Part 2 Current Program of Study

Name of Institution
Country of Institution
Level and Degree Program Name
(eg. BSc in Biology)
Program Duration
(number of years) / ____ years / Current Year of Study
(e.g. Year 3) / Year ____
Last GPA/Average Mark

Part 3 English Language Proficiency

If you have taken any international English test(s), please provide your test result(s) below.

Examination / Date of Test
(dd/mm/yyyy) / Listening / Reading / Writing / Speaking / Overall Band Score
IELTS
Examination / Date of Test
(dd/mm/yyyy) / Reading / Listening / Speaking / Writing / Total Score
TOEFL

Others, please specify:

Name of Test / Date of Test
(dd/mm/yyyy) / Result
I have not taken any international English proficiency test.

Part 4 Personal Statement

Please give a brief personal statement of about 200 words on why you wish to attend the Summer Camp 2016 and how this summer camp will benefit you.

Part 5 Self-introduction

Please prepare a 2-minute introduction, done in English, telling us who you are, what you are studying, what your plans are when you finish your program of study, and how you are going to realize your plans.

Please upload your video recording to an online platform and indicate the link below.

URL: ______

Part 6 Additional Information

Please tick as appropriate:

Disabilities and Special Needs (medical conditions, allergies etc.)
Please specify: ______
Special Dietary Requirements
Please specify: ______
Airport Pick-up in Hong Kong

Part 7 Supporting Documents

Please use the below checklist to make sure that you have prepared all the necessary documents.

A 2-minute introduction video recording

Supporting statement from your home department, if available

Official transcript and testimonial of current program of study

Copy of proof of English Language proficiency, if available

Photocopy of the personal particulars page of the travel/identity document

Part 8 Declaration

1. I declare that the information given in support of this application is accurate and complete. I understand that this information will be used in the admission decision process and that any misrepresentation will disqualify my application for admission and enrollment in HKUST.

2. I have obtained permission from my home institution to join the Summer Camp.

3. I authorize HKUST to use my data as a basis of all types of processing relevant to admission to the Summer Camp at HKUST and for all other associated purposes.

4. I understand that, upon my registration as a Summer Camp participant, this data will become a part of my student record at HKUST. That student record may be used for a number of purposes consistent with the mission of the University, including academic advising, program planning and evaluation, etc.

Signature: / Date:

Please return this completed application form by email to on or before 22 June 2016.

Page 3 of 3