Exchange-App-Form.pdf

About Global Documents

Global Documents provides you with documents from around the globe on a variety of topics for your enjoyment.
Global Documents utilizes edocr for all its document needs due to edocr's wonderful content features. Thousands of professionals and businesses around the globe publish marketing, sales, operations, customer service and financial documents making it easier for prospects and customers to find content.
applicant EXCHANGE STUDENT applicant FORM Hong Kong university
STUDENT EXCHANGE PROGRAMME / STUDY ABROAD PROGRAMME
APPLICATION FORM 
Page 1 of 4
Please read the following instructions carefully before completing this form.
3.  If you are a Chinese passport holder studying overseas, additional documents are required for your HK  
     student visa application. For details, please refer to our website: 
     http://www.polyu.edu.hk/iao/study-se-admission.html 
  
4.  All applicants are required to pay a non-refundable administrative fee of HK$500 that includes visa application 
     and courier service. The administrative fee can be settled by credit card or bank draft. Please see details 
     on section VI of this form. Please note that your application will NOT be processed if full payment is not  
     received. 
  
5.  Application Forms which are not fully completed and/or with missing supporting documents and signature 
     will NOT be processed. 
Inbound Exchange Application Form 2010/11
1.  This form can be completed electronically. Please download the form from  
     http://www.polyu.edu.hk/iao/pdf/Exchange-App-Form.pdf and complete in English in BLOCK LETTERS.  
  
2.  Please send the completed form to the International Affairs Office (IAO) together with the following documents:  
a. Curriculum vitae in English 
b. Official or certified university transcript showing all university courses taken in the past as well as courses in 
    which you are currently enrolled for. If the transcript is not in English (or Chinese), it must be accompanied 
    by a certified translation.  
c. Copy of passport identification page (valid until at least 6 months after the end of the exchange period) or  
    Hong Kong I.D. card for students who have the right of abode in Hong Kong. 
d. Financial documents from a bank verifying financial support minimum HK$20,000 (for exchange students) or 
minimum HK $55,000 (for study abroad students) per semester. Please make sure the bank document (1) 
shows the 
    name of the bank; (2) shows the name of the account holder; (3) a balance (currency specified), (4) all  
    written in English. If you are not the account owner, please ask the account owner to write a declaration with  
    personal signature that s/he will financially support your exchange study at PolyU.  
e. For student attending semester exchange, please fill in the visa application form ID995A (Page 1 to Page 4)  
    (Downloadable from: http://www.immd.gov.hk/pdforms/ID995A.pdf) 
    For student attending clinical placements, please fill in the visa application form ID992A (Page 1 to Page 4) 
    (Downloadable from: http://www.immd.gov.hk/pdforms/ID992A.pdf) 
f.  One passport size photo for PolyU student I.D. card
Application Deadlines: 
This application form and attachments should be sent to: 
First semester (Fall) 
Second semester (Spring) 
Summer semester 
15 April   
1 October
International Affairs Office (IAO) 
Re: Inbound Exchange Application 
M1601, Li Ka Shing Tower 
The Hong Kong Polytechnic University 
Hunghom, Kowloon, Hong Kong 
1 March
Enquiries: 
Email: oaexst@polyu.edu.hk
Fax: (852) 2333 9974 
Website: www.polyu.edu.hk/iao/
*Please do not attach any other documents that are not specified above.
OFFICIAL USE ONLY
I.      TYPE OF EXCHANGE 
Please select the study programme that you would like to apply for. For eligibility, 
please refer to:  http://www.polyu.edu.hk/iao/study-main.html
Student Exchange Programme    
Study Abroad Programme
Page 2 of 4 
II.     PERSONAL PARTICULARS  
Full name in English (same as printed on passport)  
Surname  
Other names in full   
Passport / Hong Kong I.D. card   
Passport no./ Hong Kong I.D. no.   
Expiry date* (MM/YY)
*Please make sure that your passport will be valid until at least 6 months after the end of your exchange study.  
Gender 
Place of birth (country) 
Nationality (current)
Please affix a 
recent photo 
here
Correspondence address    
*The student visa will be sent to the address indicated above by courier. Please do not provide a P.O. Box address. 
Please inform IAO in case of change of address.   
country code
Phone no. 
(home)
(mobile)
III. 
INFORMATION OF STUDY AT YOUR HOME UNIVERSITY 
Home university 
Country  
Major of study   
Current year of study   
IV.    EXCHANGE DETAILS     
http://www.polyu.edu.hk/iao/study-se-programmes.html 
PolyU student I.D. no.
area code
local number
local number
area code
country code
Academic programme 
Academic department that you wish to enrol during your exchange study at PolyU
Exchange period  
Semester 1 
Semester 2 
Summer Term Academic Year 20           /
[For students on clinical placement ONLY] 
Others (please specify): 
(YY)
Date of birth 
Day 
Month 
Year 
(DD) 
(MM)
Email address 1: 
  *Please write every alphabet and digit clearly. Your email address is important for our future correspondence. 
Email address 2: 
Inbound Exchange Application Form 2010/11
For academic programme and subject selection, please refer to
Page 3 of 4 
Preliminary indication of subjects opting for:
Subject title 
-   Subjects chosen here are only for preliminary reference for the host department to enrol you for an appropriate 
    programme. You will have to select your subjects again after you received the Notification of Offer from PolyU.  
-   The minimum credits required for exchange students are 9 credits and the maximum is 18 (1 subject = 3 credits = 42    
    teaching hours). Exchange students are recommended to take 4 to 6 subjects per semester.   
-   Subjects with codes starting with 5 or 6 (e.g. MM511, CSE508) are postgraduate courses and are NOT applicable to 
    exchange students.
V. SUPPORTING STATEMENT FROM YOUR HOME UNIVERSITY 
[This section should be completed by the academic supervisor at your Department/ Faculty, or Registrar]
1.  Has the applicant obtained the necessary approval from your university to study abroad?     
2.  Will the credits earned by the applicant in PolyU programme be accepted towards the degree at your university? 
       Yes, provided the applicant passes each subject with a grade of             or above.    
       No 
IV.   
Subject code 
1. 
2. 
3. 
4. 
5. 
6. 
Yes                  No 
(Prof./Dr/Mr/Mrs/Ms)  
Approval signature:   
Email: 
Title:  
Name of supervisor:   
Date:  
Credit card account no.:
The bank draft should be made payable to 'THE HONG KONG POLYTECHNIC UNIVERSITY' in Hong Kong 
dollars. Please attach the bank draft to this application form.   
[Cash cheque is not acceptable.]
       I would like to settle the HK$500 administrative fee for THE POLYU STUDENT EXCHANGE PROGRAMME  
       by bank draft.    
Date:
Signature of cardholder: 
Card expiry date:               /              (MM/YY)   
Type of credit card:          Visa Card              Master Card   
Name of cardholder:  
       I agree to pay the administrative fee of HK$500 for THE POLYU STUDENT EXCHANGE PROGRAMME to  
       The Hong Kong Polytechnic University by credit card. 
       [We only accept Visa Card or Master Card. Others types of cards, such as American Express, Diners or China   
       Union Pay Card, are NOT acceptable.]     
All applicants are required to pay a non-refundable administrative fee of HK$500 that includes visa application and 
courier service. Please select payment method below. 
VI.  
Name of applicant:  
- 
- 
- 
IMPORTANT: Your application will NOT be processed without successful transaction of the administrative fee.
ADMINISTRATIVE FEE
Inbound Exchange Application Form 2010/11
Note:
EXCHANGE DETAILS (continues)    
Page 4 of 4 
VII. AUTHORIZATION AND DECLARATION (to be completed by applicant) 
1.  I hereby authorize The Hong Kong Polytechnic University (the University) to use my data provided in this 
application form for the following purposes: 
i)    as a basis for processing my application for admission as an exchange student;   
ii)   for the University to extract from its records and for relevant institutions to provide the University with 
      information about my studies;  
iii)  for transferring to the student record system upon acceptance of my application. The data together  
      with my photo image collected at the time of registration will be used in activities in support of my 
      study at the University including those conducted by the students' organizations; 
iv)  for statistical and research purposes (all personal information such as name, passport no., address and  
      telephone no. will be deleted);
v)   for sending my academic transcript to the coordinator of my home university after I have completed    
      the exchange in the University; and 
vi)  for matching the University's local students as my buddies (only Name, Host Department, Home  
     Country, Home University and Primary Email Address will be given to the matched buddies). 
2.  I agree to abide by the law of the Hong Kong Special Administrative Region. If I am involved in any legal  
     consequence, I am responsible for any necessary legal action as well as any and all expenses incurred.    
3.  I declare that all application information submitted is true. I understand that any false declaration on my   
     part or submission of inaccurate documents may result in forfeiture of my place on this programme without 
     entitlement of any refund.  
Signature of applicant:  
Date:
VIII.   
I approve the admission of this applicant as an exchange student in my department.  
Please proceed to issue Notification of Offer on behalf of our department. The details are as follows: 
Programme title:  
Programme code:
 Stream: 
Year of study:  
 Award I.D.: 
Tuition fee:  
Tuition fee paid by student to home university  
Tuition fee (HK$40,000) per semester paid by student to PolyU   
For administrative or clerical support, please contact:  
Name: 
 Ext.:   
  Email:  
Reason of rejection: 
Signature:  
Date: 
(Head of Department) 
(Student Exchange Programme Officer)
*Please tick the appropriate
I do not approve the admission of this applicant as an exchange student in my department.  
(OFFICE USE ONLY) APPROVAL BY POLYU DEPARTMENT (to be completed by the host department) 
Inbound Exchange Application Form 2010/11