ࡱ> RTQ bjbj 4: ~ ~ 8TaL/bb/d/d/d/d/d/d/$E24N//4/}}}:b/}b/}}r+>-,N//0/,,55v55,>-55>-}//^/55~ : FACULTY OF CONSTRUCTION AND ENVIRONMENT & RESEARCH INSTITUTE FOR SUSTAINABLE URBAN DEVELOPMENTTHE HONG KONG POLYTECHNIC UNIVERSITYSummer School for Outstanding Postgraduate and Senior Undergraduate Students Application Form(Application deadline: 1 April 2013, late applications will not be accepted)Part A Information of the Applicant (Copy of degree certificates, transcript/academic results report should be attached to this application)Student name: _____________(Surname)________________(Given name)____________(Chinese Name)Sex: F/M* Nationality: ____________________ TOEFL/IELTS* result (if any): ___________Current Year of Study: _____ Duration of the Academic Programme: _____________________________Academic Programme Title: ____________________________________________________________Latest ranking in class^ (e.g. 3 out of 50 students): _________ Latest GPA/average score*^: _______Department: __________________________Name of University: _______________________________Correspondence Address: ________________________________________________________________Phone: ____________________________ E-mail: ____________________________________________* please delete as appropriate ^ if the class ranking, GPA/average score of the 2012/13 academic year are not available at the time of application, please provide the required information for the year beforeI declare that the information given above is correct and complete to the best of my knowledge and belief. I understand that if I give any false information or withhold any relevant information, I shall render myself liable to dismissal of the offer by The Hong Kong Polytechnic University.In connection with my application for the Summer School, I hereby authorize The Hong Kong Polytechnic University to seek additional information from my academic referee(s) upon receipt of my application.I undertake to abide by the regulations of The Hong Kong Polytechnic University.SignatureDatePart B Academic Referee(s) (if you have more than one referee, please complete this part in a separate form.)Name of Referee: _________________________________ Post: ________________________________Department: __________________________Name of University: _______________________________Phone: ____________________________ E-mail: ____________________________________________I am pleased to confirm/cant confirm* that the class ranking and GPA/average score provided above by the student are correct. 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