The Hong Kong University of Science and Technology
School of Humanities and Social Science
Application for HKUST – UVa Jefferson Global Seminars 2015 (JGS)
Notes:
Please complete all sections in English, and forward the completed form together with the following supporting documents to the
programme coordinator at your home University;
1) Resume
2) Statement of Interest
3) Official academic transcript
4) Copy of the travel document
5) Copy of TOEFL or IELTS Result or other Proofs on you English Language Proficiency (if any)
PART A – To be Completed by the Applicant
Proposed Period:
(1)
June 29 – July 31, 2015
PERSONAL PARTICULARS
Name (as shown on your passport):
(*delete as appropriate)
Surname
Given Name(s)
Country of Citizenship:
Hong Kong Identity Card No. (if any):
Gender:
* Male / Female
Passport No.:
Passport Expiry Date:
Place of Birth:
Date of Birth:
Name of Home University:
Major:
(DD/MM/YY)
(DD/MM/YY)
Address of Home University:
Year of Study in 2014/15 Academic Year:
Special Educational Needs (eg. disabilities, learning difficulties):
(2)
(Leave blank if there is none)
CONTACT INFORMATION
Please provide information that would allow us to contact you from the time of application.
If there are any changes after submission, please inform us as soon as possible.
Parents / Guardian’s Name:
Relationship:
Address:
Phone:
(
)
Country Code
(3)
(
)
Email:
Area Code
TENTATIVE COURSE SELECTION AT HKUST
Please refer to this website for more details
http://www.shss.ust.hk/global_experience/exchange_jgs.html .
Course enrollment is subject to confirmed course offerings, seat availability, and satisfaction and/or approval of
course pre-requisite requirements.
Priority
Course Code
No. of Credits
Priority
1
3
2
4
JGS Application Form
Page 1 of 2
Course Code
No. of Credits
School of Humanities and Social Science
(4)
STATEMENT OF INTEREST
For Undergraduate Students: On a separate sheet of paper, in English, briefly describe (within 300 words) why you
wish to participate in the JGS programme at HKUST and what you are planning to achieve from this study
experience.
For Postgraduate Students: On a separate sheet of paper, in English, to describe (within 500 words) your research
interest and proposed subject of research/study.
(5)
DECLRATION
I am applying for the JGS Programme to The School of Humanities and Social Science (“SHSS”), The Hong Kong
University of Science and Technology (“HKUST”) and declare that the information provided is accurate and
complete. I understand that provision of any false and/or misleading information shall lead to disqualification of
my application and cancellation of my resulting registration. I also authorize SHSS, HKUST and the relevant
authority to obtain and release any and all information about my candidature for public examinations and my
studies in institutions in Hong Kong and elsewhere if necessary. By signing this application, I am giving my consent
to HKUST to release my academic records at HKUST to my home university that appears in Part B below.
Applicant’s Signature:
Date:
PART B – To be Completed by the Programme Coordinator of your Home University
I recommend / do not recommend this applicant for the JGS Programme at The School of Humanities and Social Science,
The Hong Kong University of Science and Technology.
Recommendation:
Name:
University:
Department:
Post Title:
Date:
Signature:
Official Chop:
JGS Application Form
Page 2 of 2
School of Humanities and Social Science