Ref.No.: UC___/___/___

NOMINATION FORM OF 17TH ANNUAL ELECTION

______

-All the information should be written in block letter

(Please sign across the photo)

I, ______(______)

(Name of Candidate in English BLOCK CAPITAL and in Chinese)

of ______

______Year______,

(Name of Course IN FULL and YEAR)

HKPU Student I.D. Card Number: ( ),

is nominated for election as the ______of

(Post)

the ______,

(Name of Students’ Organization)

17th Session, The Hong KongPolytechnicUniversity Students’ Union2009/2010.

Section ACredentials of Nominee

Course (IN FULL): ______

( E.g. BBA(Hons) in Accounting and Finance )

Faculty/School *: _ _ FAST / FB / FH / FCLU / FENG / FHSS / SD / SHTM ____

Year *: _ Foundation / 1 / 2 / 3 / 4_ Contact No : ______

Section BEducational History (in Descending Order)

School/College/Institute Attended / From (Year) / To (Year) / Highest Level Attained

Section CExtracurricular Activities Inside / Outside of HKPU

(in Descending Order)

Association/Society/Club / Inside/Outside / From(Year) / To (Year) / Position Held

Reminder: Each member can either nominate or propose two candidates in Annual Election

*Circle as appropriate

Section D Declaration

I, confirm that:

  1. To the best of my knowledge, information and belief, I am not disqualified from being nominated or elected by reasons of any disqualification contained in the Regulations Rules and Provision of the Annual Election of the 17th Session.
  1. To the best of my knowledge and belief that the information I supplied is accurate and not misleading.
  1. I understand that any inaccurate or incomplete information may prejudice my right of being elected
  1. I have read the
  2. The Regulations, Rules and Provision of Annual Election for the 17th Session
  3. The Constitution of The Hong KongPolytechnicUniversity Students’ Union

______

Signature of Candidate

______

Name of Candidate (in FULL)

______/______/______

Date (DD / MM / YYYY)

Section E Credential of Proposer

Course (IN FULL): ______

( E.g. BBA(Hons) in Accounting and Finance )

Faculty/School *: _ _ FAST / FB / FH / FCLU / FENG / FHSS / SD / SHTM ____

Year *: _ Foundation / 1 / 2 / 3 / 4_ Contact No : ______

Reason(s) supporting the nomination:

______

Reminder: Each member can either nominate or propose two candidates in Annual Election

*Circle as appropriate

______

Signature of Proposer

______/______/______

Date ( DD / MM / YYYY )

Notes

  1. All Nominees, Proposers, and Seconders must be the members of The Hong Kong Polytechnic University Students’ Union and must fulfill the Regulations, Rules and Provisions of the Annual Election of The Hong Kong Polytechnic University Students’ Union.
  1. Forms must be returned at or before 6:00pm of 2nd January 2010.
  1. Please sign beside any corrections.

For Office Use Only

Received by:______

Received Date:______

Received Time:______

Person in charge:______(Name)

______(Post)

______(Signature)

Checked by:______

Checked Date:______

Person in charge:______(Name)

______(Post)

______(Signature)

Approval:YES / NO

Approved by:______

Approved Date:______

Person in charge:______(Name)

______(Post)

______(Signature)

17th Annual Election HKPUSU