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Student Number
(for ADMO use only)

For the use of College / School / Departmental level exchange applicants. Applications should be sent directly to the respective academic units of CityU.

The following supporting documents should accompany your application:

academic transcript

TOEFL / IELTS / CET results, if English is not the medium of instruction at your home university.

1
Semester A 20___ / ___

Semester B 20___ / ___

Summer Term 20___ / ___

2
Name in English
Surname / Last Name
First / Other Names

Name in Chinese (if applicable)

ID / Passport Number
Gender

Issuing Country
Date of Birth

M Male
F Female

Day

Place of Birth

Month

Nationality

Year

(For mainland applicants, please also indicate home province / city )

3
Correspondence Address

Phone No.
Email Address
Emergency Contact Person

Relationship

Emergency Contact Phone No.

4
Home University
Programme / Major of Study
Year of Study: currently in year

of a

year programme

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Please list the undergraduate courses (level B courses) that you plan to take at CityU. Information on the courses to be offered is
available at http://www.cityu.edu.hk/admo/exchange. The timetable and course offerings for your exchange semester will be available at
http://www.cityu.edu.hk/arro/crsreg three weeks before the start of semester.
The normal load for a full-time student is 12-18 credits for Semester A and B, and 7 credits for the summer term. While we will endeavour to
arrange course pre-registration for you, there is no guarantee that your course preference can be met. Subsequent changes to your course plan
can be made when you are granted on-line access to the course registration system nearer the start of semester/term.
Preferred Courses
Course Code

Course Title

1
2
3
4
5
Alternative Courses (if the above courses are not available)
Course Code

Course Title

1
2
3
4
5

6
English

Chinese (Only applicable to students planning to study Chinese related courses)

English is my first language.

Yes

No

I do not know Chinese

English is the medium of instruction

of my home university.

Yes

No

I know Chinese and my level of proficiency is:

Written Chinese:

Good

Fair

Poor

Putonghua:

Good

Fair

Poor

Cantonese:

Good

Fair

Poor

Spoken Chinese:

Other Languages (if any)

Please indicate the language other than English and Chinese that you are proficient in:

7
If you are to be affiliated with the College of Science and Engineering and plan to take a minimum of 9 credits of courses offered by the College,
you may apply for an exchange scholarship. Details are given at http://www.cityu.edu.hk/cse/student_corner/student_corner.htm.
Interested applicants should submit the relevant application form (available at the website above) together with this exchange application.

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I declare the information set out in this application or any attachment is, to the best of my knowledge, accurate and complete. I understand
that the information will be used in the admission decision process. Upon my enrolment with the University, relevant data will become part
of my student record and may be used for purposes in accordance with the procedures of the University.

Signature of Applicant _____________________________________________________ Date__________________________________