Application Form for International Summer School 2013

Application Form for International Summer School 2013

Important Note for filling in the application form:

Eligibility

Type of Student / Modality of Programme / Programme Fee
HKIEd students
local UGC funded students / Credit-bearing only / HK $10,000
local self-funded students / Credit-bearing only / HK $12,200
Students from Partner Institutions / HK $10,000
with Student Exchange Agreement / Credit-bearing only
without Student Exchange Agreement / Non credit-bearing only
Students from non Partner Institutions / Non credit-bearing only

Note:

-new 4/5-year UG programmes students could take the credit bearing summer school course for fulfilling

requirement of elective domain under the 4/5-year programme curriculum; and

-an additional fee of HK $460 is needed for student visa application if necessary.

PERSONAL DATA

Full Name (as shown on passport)
(Salutation) / Mr / Mrs / Miss / Ms* / (Chinese name)
(if applicable)
(Surname) / (Given Name) / (Middle Name)
Gender / Male / Female* / Date of Birth (dd/mm/yy)
Nationality / HK ID number
(if applicable)
Passport No / Passport Expiry Date
Correspondence Address in English
Home Phone No.
(with country code) / Mobile Phone No.
(with country code)
Email Address
Note: Please check your email frequentlyand response to our email(s) promptlyas we will be contacting you via email should there’s any information that required your attention.

ACADEMIC INTERESTS

Home Institution & Country
Current Level of Study / Year 1 / 2 / 3 / 4 / 5* / Of / 3-year / 4-year / 5-year* / Curriculum
Mode of Study / Full time / Part time*
Expected Degree/Major of Study
(e.g. Bachelor of Social Science Education (Honours) (Greater China Studies))
Note: Please submit along with your official transcript.
*Delete as appropriate
I would like to enroll the International Summer School and take the course as a:
6 credit bearing course non-credit bearing course
Please mark “X” where appropriate

EMERGENCY CONTACT

Name / Relationship to you
Home Phone No. / Mobile No.
Email

HEALTH DECLARATION

Please list below any medical / health conditions (e.g. allergies, chronic illnesses, psychological conditions, etc) which you have now / in the past, and/or any special concern or need:

DECLARATION OF INSURANCE ARRANGEMENT

You are required to make your own arrangements for travel and health insurance cover the entire period of stay in Hong Kong, Macau and Thailand. Insurance coverage should include (but not limited to) travel, personal accident, medical expenses (accident and non-accident), hospitalization and emergency evacuation/repatriation, etc. You are required to provide proof of coverage prior to arrival.

I hereby declare that I will arrange my own insurance at my home country and provide details of the coverage to the HKIEd prior to my arrival in Hong Kong. I understand that it is my responsibility to maintain a valid insurance which cover my entire period of stay. Should I fail to do the above, I am solely liable for any consequences that may arise.
Please mark “X” where appropriate

PROGRAMME FEE AND CANCELLATION POLICY

All successful applicants should pay a total of HK$10,000 / HK$12,200 as programme fee according to their eligibility; andan application fee for student visa if necessary. The payment shall be made by cheque, T/T (for group payment) or via ATM before the designated deadline.

Organizers reserve the right to cancel the Summer School Programme 2013 due to insufficient enrollment with full refund (including visa applications, if any). Such decisions will be announced at least a month before the scheduled programme date. Registrants will be notified through email (effort will be made to avoid cancellations).

Applicant finds it necessary to cancel his / her registration is eligible for a full refund (i.e. HK$ 10,000 / HK$ 12,200 only) if he / she inform us of the cancellation within 10 working days upon receipt of payment. NO reimbursement will be made afterwards. Request of cancellation must be submitted via email or by mail. Phone calls/ message will not be accepted.

I understand that onceadmitted, I am required to pay all aforementioned fees before the designated deadline(s) and the cancellation policy is well observed.
Please mark “X” where appropriate

Visa or Entry Permit for Visit to Hong Kong, Macau and Thailand

Please refer to the programme website at http://www.ied.edu.hk/iss/2013 for more details regarding the visa requirement for Hong Kong, Macau and Thailand.

I understand that if admitted, I am fully responsible for applying for and obtaining the necessary visa(s) or Entry Permit(s) for participating all the programmes scheduled in Hong Kong, Macau and Thailand prior to my arrival to Hong Kong.

DECLARATION

i.I hereby declare that the information provided above is accurate and complete. It is my responsibility to inform the institution of the updates (if any) and the misrepresentation will lead to disqualification of my application for admission in this programme.

ii.I authorize my information provided will be used in the admission process and other purposes in support of my participation in this programme.

iii.Should I fail to do any of the above, I am liable for any consequences that may arise.

Signature of Student / Date
Name of Student
(Please print)

APPLICATION RESULT

The application result will be announced by email after reviewing of your application, please refer to the key dates below.

Key Dates

Application deadline / 3 May 2013
Announcement of Application Result / Result will be announced by email after reviewing of application
Signed Notice of Acceptance and
Make Full Payment / Within 1 week after application result announcement

ENQUIRIES

Course Information

Department of Asian and Policy Studies (APS)

Tel: (852) 2948 7464

Email:

Logistic Arrangement

International Office

Tel: (852) 2948 7654

Email:

Completed application should be submitted to the International Office via email at or fax to 852-2948-8198.

The Hong Kong Institute of Education, 10 Lo Ping Road, Tai Po, Hong KongPage 1