The 3rd Summer Course on Environmental and Human Health: Impact Assessment

Hong Kong, China, 4 – 17 July 2010

申请表Application Form

姓名(Name)学生类别

(Student type)

□ 硕士研究生(Master student)

□ 博士研究生(PhD student)

□ 其他专业人士(Other professional)

专业(Major)单位名称

(University/Institute)

单位地址(Address)

电子邮箱(Email) 联系电话(Phone)

英文能力(English Skills)

Reading WritingListening and

speaking□excellent □good □fair

□excellent □good □fair

□excellent □good □fair

是否愿意做口头报告或墙报展示？Do you like to give an oral/poster presentation?

□ 口头 oral□ 否 No

□ 墙报 poster

是否申请经费资助？Do you want to apply for financial support?

□ 是 Yes

□ 否 No陈述您的研究兴趣及申请资助理由（可加页，如有相关证明，可附于申请表后）：A personal statement of your research interests and advantages (Additional information or materials can be attached to the application form):

State Key Laboratory in Marine Pollution (City University of Hong Kong)海洋污染國家重點實驗室

(香港城市大學)

Department of Biology and Chemistry

The 3rd Summer Course on Environmental and Human Health: Impact Assessment

Hong Kong, China, 4 – 17 July 2010

推荐信LETTER OF RECOMMENDATION

申请人姓名(Name or Applicant):推荐人姓名(Name of Referee)

与申请人关系(Relationship with the Applicant)

职务(Position and Title)

所在单位(Institution)

电话(Phone) 邮箱(Email)To the Referee: You are named by the applicant as a referee for his/her application for joining the Summer Course on

Environmental and Human Health : Impact Assessment which will be held in Hong Kong, 4-17 July, 2010. We would

appreciate your opinion of his/her academic performance. Please fill this form, sign your name and return it to the applicant.

Recommendation:

Signature Date

To the Applicant: Applicant should have at least one reference letter from advisor or others, and should send

this letter to the secretariats either by fax or email.

Mainland students: to Ms. Vera Shi (email: vera_shiwei@xmu.edu.cn or fax: 86-592-2184101)

Overseas & Hong Kong students: to Ms. Grace Ng (email: songrace@cityu.edu.hk or fax: 852-2788 7406)

State Key Laboratory in Marine Pollution (City University of Hong Kong)海洋污染國家重點實驗室

(香港城市大學)

Department of Biology and Chemistry