Application Form for Admission To

Application Form for Admission to

Executive Master of Arts in International Educational Leadership and Change

· Please read the Prospectus carefully before completing this form.

· Please use BLOCK LETTERS in English.

date of entry, Mode of Study and Study Track
Please choose your preferred date of entry with a “P”.
£ July 2016 (25th July – 16 Sept) £ October 2016 £ January 2017 £ April 2017
Please select your mode of study and study track with a “P”.
Mode of Study
£ Part-time (C2M004) / Study Track
£ Professional Practice Track
Personal Particulars
Please enter information in this section as shown on your HKID Card/Mainland ID Card/Passport.

Full Name in English

Surname
Other Names
Name in Chinese / Sex / M = Male
F = Female
H.K. Identity Card
No. / - / ( / ) / Date of Birth / ／ / ／ / 1 / 9
Day / Month / Year
Mainland ID Card
No.
Province/City
(where you have your household registration)
Passport No.
(for those without HKID/Mainland ID card / Nationality
Do you require a Student Visa/Entry Permit* to study in Hong Kong? / £ / Yes / £ / No
* Persons who do not have the right of abode or right to land and wish to enter Hong Kong for the purpose of education are required to obtain a student visa/entry permit issued by the Hong Kong Immigration Department.
Correspondence Information
Correspondence Address
Postal Code (if applicable) / £ Overseas Address (Please “ü” as appropriate)
Mobile Phone No.* / Daytime Contact Telephone No. / Evening Contact Telephone No.
E-mail Address*
* You will be informed of your latest application status, such as application acknowledgement, interview arrangements, etc., via your personal e-mail and mobile phone (SMS messages applicable to local applicants only) registered here. No letters will be posted to you except in very special circumstances. Therefore, please make sure that your e-mail address and mobile phone no. are correct.
Information on Disability
Applicants with a disability please put a “Y” in the box below and state the nature and degree of disability. Otherwise, please put an “N”.
All applicants will be considered on the same basis. The collection of information about the nature and degree of any disabilities will be used by the University to assess the provision of facilities to benefit students from the studies.
Academic Qualifications
List chronologically the colleges and universities you have attended, the dates attended, and the diplomas or degrees received. Please attach copies of certificates and transcripts with a complete record of the courses attended and examination results. If you are our graduate in 1995 or after, you NEED NOT submit any copies of academic transcript(s) and certificate(s) obtained at the University.
1. / Name of Institution / Country
Title of Award
Award Classification / Language of Instruction
(e.g. English, Chinese, etc.)
Major Discipline / Minor Discipline
Duration / Date of Graduation
Year(s) / Month / Year
2. / Name of Institution / Country
Title of Award
Award Classification / Language of Instruction
(e.g. English, Chinese, etc.)
Major Discipline / Minor Discipline
Duration / Date of Graduation
Year(s) / Month / Year
3. / Name of Institution / Country
Title of Award
Award Classification / Language of Instruction
(e.g. English, Chinese, etc.)
Major Discipline / Minor Discipline
Duration / Date of Graduation
Year(s) / Month / Year
4. / Name of Institution / Country
Title of Award
Award Classification / Language of Instruction
(e.g. English, Chinese, etc.)
Major Discipline / Minor Discipline
Duration / Date of Graduation
Year(s) / Month / Year
Professional Qualifications
Please attach official documentary evidence.
Type of Membership / Abbreviation / Awarding Institution and Country / Date of Award
(Month/Year)
English Language Requirement
If you are a non-native English speaker, you need to provide proof on your English proficiency. Please provide the most recent information concerning examinations you may have taken and attach copies of the official score reports.
Public Examination / Subject/Format / Year of Attempt / Grade/Score
IELTS / Academic Level (Overall Band Score)
TOEFL / £ Paper-based
£ Computer-based
£ Internet-based
Chinese Mainland’s College English Test (CET) / Band 6
Others (please specify)
Working Experience
Please list chronologically your full-time working experience.
Date (Month/Year) / Organisation / Position/Title / Responsibilities
From / To
Date (Month/Year) / Organisation / Position/Title / Responsibilities
From / To
Academic/Professional Referees
Please give the name and correspondence information of two persons who can provide references covering your career and your suitability for study leading to a higher degree, and ask your referees to return the report as soon as possible before the application deadline.
Name :
Position :
Organisation :
Address :
Contact Number :
E-mail : / Name :
Position :
Organisation :
Address :
Contact Number :
E-mail :
Expectations
Please provide below a statement (250-300 words) explaining what you expect to accomplish through this IELC programme, why you are suitable for it, and what specific benefits you anticipate (please use additional sheets if necessary).
Source of Information on IELC
How did you learn about the application of this IELC programme? Please “P” as appropriate and you may choose more than one item below.
£ IELC website / £ IELC prospectus / £ IELC leaflet
£ IELC information seminar / £ Advertisement/report/article / £ Your school/company
£ Others (please specify: / )
Declaration
1. I declare that all the information given above in support of my application is to the best of my knowledge accurate and complete. I understand that any omission or misrepresentation of information will lead to disqualification of my application for admission and subsequent enrollment in the University.
2. I authorise The Education University of Hong Kong to:
(a) use my data as a basis for various types of processing in relation to my application;
(b) have my personal data transferred to the student record system of the University upon my admission to the programme;
(c) use my data (except all personal identifiers such as name, HKID number) for statistical and research purposes;
(d) obtain from the relevant examination authorities, assessment bodies or academic institutions in Hong Kong and elsewhere any and all information about my public examination results, records of studies or professional qualifications; and
(e) use my data to carry out checks of my applications, and any records of my studies in the University and other institutions in Hong Kong and elsewhere.
Signature of Applicant: Date:
Instructions
Before submitting your application, please check if you have:
£ chosen the date of entry, mode of study and study track;
£ paid the application fee (please attach the original payment receipt);
£ attached a copy each of the academic documents stated in your application;
£ indicated the names and correspondence information of two referees and ask them to complete and return the “Referee’s Report” to the Registry; and
£ signed and dated the application form.

Executive Master of Arts in International Educational Leadership and Change

Referee’s Report (confidential)

To : Admissions and Registrations Section

The Registry

The Education University of Hong Kong

Room A-2/F-07, Administration Building

10 Lo Ping Road, Tai Po

New Territories, Hong Kong

E-mail :

Fax : (852) 2948 6162

Note to the Applicant:

· Please provide this form to two persons who are qualified to assess your potential for graduate study in an Executive programme. We would prefer if one of the referees was a former university teacher and one a current supervisor. If it is not possible to get a reference from a former professor, please provide two references from supervisors and colleagues at work.

· Please note that your referees have 4 options for submitting the reports.

Note to the Referee:

The person who has provided you with this referee’s report is applying for the Executive Master of Arts in International Educational Leadership and Change programme at The Education University of Hong Kong. It would assist our faculty if you could provide an assessment of the applicant as outlined below:

· This form in electronic copy can be downloaded from www.eduhk.hk/ielc/. Please return this form to the applicant in an envelope with your signature across the seal. The applicant will then submit the sealed and signed envelope as part of his/her completed application directly to the Admissions and Registrations Section of The Education University of Hong Kong.

· Alternatively, you may fax the completed form to the attention of the Admissions and Registrations Section of The Education University of Hong Kong; or

· Mail the form to us directly at Room A-2/F-07, Administration Building, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong; or

· E-mail the signed referee’s report to .

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CONFIDENTIAL

We realise that considerable time and effort is involved in preparing this evaluation and we greatly appreciate your help.

Applicant’s Full Name in English:

Referee’s Name: Professor/Dr/Mr/Ms/Mrs*

Position:

Organisation:

Work Address:

Telephone: E-mail:

* Please delete as appropriate.

Referee’s Report (confidential)

1. How long have you known the applicant and in what relationship?

No. of years: Relationship:

2. Please evaluate the applicant in terms of the qualities listed below (please “ü” as appropriate):

Criteria for Assessment / Excellent / Very Good / Good / Average / Below Average / No Opinion
Intellectual Ability
Imagination and Creativity
Specialised Knowledge in Education
Demonstrated Leadership Skills
Writing Skills
Speaking Skills (English)
Interpersonal Skills
Ability to Work Independently
Sense of Initiative
Motivation for Further Study

3. Briefly describe the applicant’s qualities which qualify him/her to study for an Executive programme in Educational Leadership.

4. Are there any obstacles that you anticipate could interfere with the applicant’s ability to complete a Master degree programme that will require significant independent study?

5. Is there any other information that you would like us to know about the applicant that is relevant to his/her application for the Executive Master of Arts in International Educational Leadership and Change programme?

Signature of Referee: Date:

Academic Referee’s Report (Applicable to Executive Master of Arts in International Educational Leadership and Change only)

By post: Admissions & Registrations Section, Registry

The Education University of Hong Kong

10 Lo Ping Road, Tai Po

New Territories, Hong Kong

E-mail :

Fax: (852) 2948 6162

Note to the Applicant:

· Please remind your referees to return the form directly to Registry by the application deadline.

Note to the Referee:

****************************************************************************

CONFIDENTIAL

We realize that considerable time and effort is involved in preparing this evaluation and we greatly appreciate your help.

Applicant’s Full Name in English: (*Please delete as appropriate)

Referee’s Name: Professor/Dr/Mr/Ms/Mrs*

Position:

Organisation:

Work Address:

Telephone: E-mail:

1. How long have you known the applicant and in what relationship?

No. of years: Relationship:

4. Please evaluate the applicant in terms of the qualities listed below (please “ü” as appropriate):

5. Briefly describe the applicant’s qualities which qualify him/her to study for an Executive programme in Educational Leadership.

4. Are there any obstacles that you anticipate could interfere with the applicant’s ability to complete a Master degree programme that will require significant independent study?

Signature of Referee: Date:

IELC Application Form (May 2016) Page 1 of 8