Admissions Section, Academic Registry For Office Use

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Application Form for Admission to 2009-10 Kearny Journalism Scholarship

Application Number

Return applications no later than January 5, 2009 to kearnymyanmar@gmail.com or N08

PO Box 8, Mae Ping Post Office, Chiang Mai, 50301, Thailand.

Please submit the completed form with relevant supporting documents

Part A Personal Data (Write in block letters.)
Name (Name on Passport)

Surname

Other Names

中文姓名 Sex (M/F) Date of Birth Passport No

year month day

Correspondence Address

Home Phone No. ____________________ Mobile Phone No. ____________________ Fax. No. ___________________

E-mail Address (An E-mail address must be provided as we may communicate with you via email)

To facilitate interview arrangement, if any, please ‘ ’ this box if you are currently studying or residing overseas √

If you are a “non-local student”, please state your country of origin: Myanmar
(Non-local students are those who need to get hold of a student visa/entry permit issued by the Director of Immigration to enter Hong Kong for the purpose of
education.)

Part B
Choice of Degree Programmes (1. Masters of International Journalism Studies)

Choice Programme Title

First Masters of International Journalism Studies

Part C Study Year Apply For (Please tick one box only )
√ Year 1

Part D Applicant with a Disability (Please refer to Part D of Notes on Application for details.)

Are you a student with a disability? No Yes

If yes, please indicate the nature of disability and attach supporting document that certifies your disability.

1
Part E Category of Application (Refer to Part E of Notes on Application for details)

Please tick ( ) one category only which reflects the HIGHEST qualification you have attained; or you may tick put a ( ) beside “Mature
Applicant” if you do not belong to any category below but are aged 25 or above on September 1, 2008.

Graduated from a bachelor degree

Completed third year of a bachelor degree

Completed second year of a bachelor degree
Completed first year of a bachelor degree
Name of Institution: ___________________________________________

Graduated from a masters degree

Name of Institution: ___________________________________________

Internationally accreddited high school qualification

(such as GED, IGCSE)

Mature Applicant (Parts H to I must be filled in)

Part F Academic Qualifications & Examination Results

Please list details of your academic qualifications and examination results in chronological order in the following tables:

1. Secondary Education
Name of Secondary School Level Attended/ Period Qualifications Obtained/To be Obtained
and Country/ Region Attending (YYYY/MM) (GED, GCSE/IGCSE/GCE, IB and
other public exam results)
from to

2. Post-Secondary Education
Name of College/University Level Period Study Programme Programme Title Latest
and Country/ Region Attended / (YYYY/MM) Mode Duration & Major Study Cumulative
Attending (FT/PT/DL)# (Please state no. e.g. Associate of Arts – GPA /
of years)
Business Average
Score
from to

# FT: full-time, PT: part-time, DL: distance-learning

2
 Which programme concentration are you applying for? (tick one)

____ Concentration in International Journalism

____ Concentration in Business and Financial Journalism

3. Public Examinations Results

c. International Examinations such as GED, IB, IGCSE

Examination Year of Country/ Subjects Taken and Grades
Attempt Region

d. Other English Language Qualifications

Examination Year of Attempt Score Examination Year of Attempt Score / Grade

TOEFL Paper Computer Internet Others (Please specify)

-based -based -based

IELTS
(Academic Level)

3
Part G Other Academic/Professional Qualifications

Professional Body and Country Name of Award / Qualification / Level/Grade Date of Award
Examination

Part H Working Experience (Including Full-time, Part-time and Relevant Voluntary Work)
(Only applicants applying under the category “Mature Applicant” are required to provide supporting documents
on working experience at this stage.)
Date Name of Organization Post Duties Full-time/
(YYYY/MM) Part-time/
Voluntary
from to

Part I Additional Information (Please provide information which may be helpful to your application, such as
reasons for application, career aspiration, personal strengths, hobbies and interests, voluntary services, etc. Use
separate sheet if necessary.)

Please attach the following documents:

1. Copies of all educational transcripts including official English test scores.

2. A 500 word statement in English outlining your academic interests and objectives and your
future plans. If available, also attach a sample piece of journalism and/or research paper.

Part J Declaration (Please do not delete any item of this part)

1. I declare that the information given above in support of my application is accurate and complete to the best of my knowledge. I understand that such
information will be used as a basis for selection for admission to the graduate programmes and other related or relevant purposes and that any
misrepresentation will disqualify my application for admission and enrolment in the University.
2. I authorize the University to use my data to carry out checks on multiple applications and records of previous studies in various institutions/schools.
3. I understand that, upon successful outcome of my application, the relevant data will become a part of my student record and may be used for all purposes
relating to my study in accordance with the procedures of the University.
4. I authorize the University to obtain, and the relevant examination authority or academic institution in Hong Kong or elsewhere to release, information
about my public examination results, records of studies or professional qualifications, if deemed appropriate.

Signature Date