Financial Engineering Program APPLICATION FOR ADMISSION PERSONAL DETAILS Full Name (as it appears on your passport) Family Name

Given Names

Name Preferred on Certificate

Sex:

… Male

… Female

Date of Birth: (D) ____/ (M) ____/ (Y) ____

Home Address

Work Address

Which address should we use for correspondence? … Work … Home Contact Number Home

Work

Mobile

Email Address Email address 1 What is your official residential status?

Email address 2 … H.K.

… U.S.

… Others _________

Please indicate where you heard about Stanford Financial Engineering Program: … Email __________________________ … Website ________________________

… Newspaper ___________________________ … Others _______________________________ 1

ACADEMIC QUALIFICATION Please provide details of your academic qualifications. In chronological order, list all college and universities and specialized institutions you have attended. Attached supplemental list if necessary and provide one certified/official transcripts with English translations of each university/college attended.

Name of University/College and Location

Course Undertaken and Qualification Gained

Graduation Date

ENGLISH LANGUAGE PROFICIENCY Have you complete a degree where the primary language of instruction was English? … Yes, please state the qualification and the institution: ______________________________ … No, have you taken an English language test? … No … Yes* * English Test Name: ____________________________________ Result: _______________ I plan to take: … …

English Language Proficiency test and personal interview. English Language Proficiency Interview only. I request to be waived from the English Language Proficiency Test because I am an English speaker. … Citizen of: ____________________________ Country

PROGRAM INFORMATION I am applying to the Financial Engineering Program offered by Stanford University in Hong Kong. Intake

Year 2

SUMMARY OF WORKING EXPERIENCE Please provide a clear outline of your employment/work history starting with most recent. Period

Position

Organization Name

Job Descriptions

From: To:

From: To:

From: To:

From: To:

From: To:

Total years of working experience: ________________ years. Total years of management/professional of experience: _______________ years.

In addition to complete the above table, please attach your resume.

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STATEMENT OF PURPOSE Please type or print a one-page essay outlining your goals for pursuing the Stanford Financial Engineering Program as well as your academic and professional experiences, which are relevant to your chosen field of study, and attach the statement to this form.

CERTIFICATION Have you ever been convicted of a criminal offense other than a minor traffic violation? …

Yes, please explain: _______________________________________________

…

No

…

No

…

No

Are there such criminal charges pending against you at this time? …

Yes, please explain: _______________________________________________

Have you ever been dismissed, suspended or placed on probation by any school? …

Yes, please explain: _______________________________________________

I hereby certify that the above information is accurate. I understand that falsifying or withholding information in completing this application constitutes grounds for immediate withdrawal of my application from further consideration, cancellation of admission, or registration.

______________________________________

_______________________________

Name and Signature

Date

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STUDENT CONSENT TO RELEASE EDUCATION RECORDS Name of Student (Print): ______________________________________________________________________ Last Name/Family Name

First Name/Given Name

Date of Birth: _________/_________/___________ (MM/DD/YR) I, the undersigned student, hereby authorize Stanford University to share educational records and all related documents and records that pertain to my admission, continued enrollment, and graduation status in the Stanford University program. I understand further that although my participation in the Stanford University program is contingent on my consent to the release of my education records as provided herein, (1) I have the right not to consent to the release of my education records; (2) I have the right to receive a copy of such records upon request; (3) this consent shall remain in effect until my written revocation is delivered to the University Registrar, and (4) that any such revocation shall not affect disclosures made by Stanford University prior to the receipt of any such written revocation.

___________________________________________

____________________________________

Signature

Date

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