63/1105nursing.hku.hk/programs/download/DNurs_App_Form.doc · Web viewFor admission to the DNurs programme, applicants are required to complete the application form AND submit a

DN001/2010THE UNIVERSITY OF HONG KONG

LI KA SHING FACULTY OF MEDICINEDEPARTMENT OF NURSING STUDIES

Application for Admission to theDoctor of Nursing (DNurs)

Applications are invited for admission in September 2010 to the Doctor of Nursing Programme.

Candidates should hold a Master’s degree in nursing or equivalent disciplines accepted by the University, a current Registered Nurse Licence.

The DNurs is a professional, practice-focused doctoral degree for experienced nurses who aspire to provide leadership in evidence-based practice and nursing education. The DNurs graduates are experts in specialized advanced nursing practice or nurse educators in practice or academic settings.

The DNurs programme is offered in a part-time mode. Students begin their studies in September for the relevant academic year. The curriculum shall normally extend over a period of not less than 48 months and not more than 72 months of part-time study.

The DNurs programme consists of 4 Core modules, 3 Track modules and a Thesis. Candidates select the Track modules from one of the two Leadership Tracks: Clinical Leadership or Educational Leadership.

Time Frame Coursework ThesisPhase I1st to 24th month

1. DNurs Core modulesa. Take 4 DNurs Core modulesb. Assignment: as specified for the individual

modules

Preparation of detailed research proposal plus initial work on thesis

2. DNurs Track modulesa. Take 3 DNurs track modulesb. Assignment: as specified for the individual

modulesPhase II25th to submission of thesis

Confirmation of candidature1. Completion of DNurs Core and Track modules;2. Completion of a detailed research proposal; and3. Presentation at a confirmation seminar

Thesis1. Attendance of thesis seminars2. Presentation at thesis seminars3. Completion of a thesis of 50,000 to

60,000 words

For admission to the DNurs programme, applicants are required to complete the application form AND submit a 2,000 word statement indicating their research interest. Applicant should also provide two academic referees who can comment on the applicant’s academic ability and his/her suitability for undertaking the DNurs degree.

Applications can be submitted in a hard-copy format (forms can be downloaded from the DNurs webpage at http://www.hku.hk/nursing/) to DNurs Programme Administrator, Department of Nursing Studies, 4/F William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong by 15 March 2010.

Applicants may be required to attend an interview and/or sit for a test arranged by the Department as part of the selection process. Results will be announced around six weeks after the application deadline by e-mail and post. For enquires, please contact the DNurs Programme Administrator, Department of Nursing Studies at tel. 2819 2688, e-mail: n sro @hku.hk or visit our website: http://www.hku.hk/nursing/.

Nov 2009

http://www.hku.hk/nursing/

mailto:[email protected]

http://www.hku.hk/nursing/

THE UNIVERSITY OF HONG KONGLI KA SHING FACULTY OF MEDICINEDEPARTMENT OF NURSING STUDIES

Doctor of Nursing (DNurs)

APPLICATION FOR ADMISSION 2010-2011

Please read the General Information and Instructions before completing this form. You should provide all the information requested in this section. If you are admitted to the University, it will be filed for reference. It will be accessible only to those responsible for processing your application, or for administrative and academic aspects of your candidature. Under the Personal Data (Privacy) Ordinance, you have full access and correction rights to items 1 - 9 of this form, which you may exercise by writing to the Data Protection Officer, The Registry, the University of Hong Kong. If your application is unsuccessful, the form and all the supporting papers will be destroyed.

1. DEGREE & CANDIDATURE

Degree:

Doctor of Nursing Mode of Study: Part-time

Proposed Track of Study: Clinical Leadership Track : - Advanced Practice Nurse (APN) Role Acquisition- Health Behavior and Health Promotion Research- Concepts and Methods in Health Services Research

(Please select one)

Educational Leadership Track : - Introduction to Clinical and Classroom Teaching in Nursing- Curriculum Planning and Development- Assessment and Evaluation

2. PERSONAL INFORMATION

Mr. Miss Ms. Mrs. Others

Surname

Given Names

Name in Chinese characters (if any)

C.C. Code (for HKID card holder only)

Sex Male Female Date of Birthdate mont year

HKID Card No. ( )

Passport No. (If not holding HKID card)

HKU Student No. (If applicable)

Correspondence Address

P O S T A L C O D E

Day-time Contact Phone No(s). 1.

2.

Fax No.

Email Addresses 1.

2.

Are you a Registered Nurse? Yes No

Do you have the right of abode in Hong Kong? Yes No

Do you need a student visa to study in HKU? Yes No

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FOR INTERNAL USEApplication No. Date Rec’d Data entered by Date Form sent to FacultyDate

3. CURRENT ACADEMIC STUDIES

1. Title of degree: Full-time Part-timeMajor subject: GPA (if applicable): out ofYear of study: Duration of Programme:Institution:

Country: Expected date of award: date mont year

Language of instruction: In English Not in English By coursework research both

4. ACADEMIC QUALIFICATIONS (Attach officially certified documentary evidence#)

1. Title of degree: Full-time Part-timeMajor subject: Duration of Programme:Honours (if applicable): GPA (if applicable): out of Institution:

Country: Date of award:date month year








5. PROFESSIONAL QUALIFICATIONS

(Attach officially certified documentary evidence#)Type of Membership Abbreviation Awarding Institution Date of Award

# Please note that the University will only ACCEPT originals or copies of the documents that have been duly declared as true copies before a notary public (e.g. a Commissioner for Oaths at a City District Office in Hong Kong). You may also bring the originals of the documents together with an additional set of their photocopies to the Academic Services Office, UG-05, Knowles Building for verification. Copies of documents may be certified by the appropriate officials of your home institute if you are an overseas applicant. No photocopies will be accepted.

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6. WORKING EXPERIENCE

Organization / Employer Position Held Nature of Duties Mode Date (M/Y)

From To

FT or PT

FT or PT

FT or PT

7. ENGLISH LANGUAGE PROFICIENCY TEST(for applicant from institutions outside Hong Kong where the language of instruction and examination is not entirely in English)

Test Requirements Identification Number Score Date of Test

TOEFL Paper-based test: score 550 or aboveInternet-based test: score 80 or above

IELTS Band 6 with no subtest lower than 5.5GCE Grade C or aboveIGCSE Grade C or aboveCPE Grade C or above

8. ACADEMIC REFEREES (Please nominate two referees)

Name NamePosition PositionOrganization OrganizationAddress Address

9. ADDITIONAL RELEVANT INFORMATIONPlease provide in the space below any additional relevant information that may be of assistance to the University in considering your application. (e.g. list of publications, academic awards received and summary of relevant experience. Please attach separate sheet if necessary.)

10. DECLARATIONI declare that the information and documents provided in support of this application are, to the best of my knowledge, accurate and complete and understand that my application will be disqualified if any information or document provided is found to be false. I agree that if I am admitted, my candidature will be probationary in the first instance and subject to the relevant degree regulations of the University.

Date: Signature:

11. SOURCE OF INFORMATIONPlease tick the appropriate box(es) to indicate where you learned of our Doctor of Nursing (DNurs) programme:

Department Website HKU World Wide Web Staff / students from HKULocal Newspapers Overseas Newspaper / magazine ProspectusPromotion Activities (e.g. road show, seminar, postgraduate fair, information day.)

Others

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Checklist for submitting an application:

Application Form

Proof of payment of application fee (local applicant) or bank draft (non-local applicant)Bank draft no.: _______________________

Academic certificate and complete transcripts of your undergraduate and postgraduate studies#

Copy of Registered Nurse Licence#

Two academic referee’s reports(to be sent directly by the referees or in a sealed envelope signed by the referee)

Statement of proposed research area

Official score report of TOEFL, IELTS, GCE, IGCSE or CPE*(for applicants from institutions outside HK where the language of instruction and examination is not entirely in English)

Other documents which you would like to bring the attention of the University(e.g. list of publications, documentary evidence of academic awards received and professional qualifications, and summary or relevant experience)

* The University will NOT accept any examinee’s score record sheet. Please arrange with the examining organization/institution to send us an official score report.

# Note: Please note that the University will only ACCEPT originals or copies of the documents that have been duly declared as true copies before a notary public (e.g. a Commissioner for Oaths at a City District Office in Hong Kong). You may also bring the originals of the documents together with an additional set of their photocopies to the Academic Services Office, UG-05, Knowles Building for verification. Copies of documents may be certified by the appropriate officials of your home institute if you are an overseas applicant. No photocopies will be accepted.

Documents once submitted will not be returned.

May 2009

224/1204

THE UNIVERSITY OF HONG KONG

Personal Information Collection Statement

1. This is a statement to inform you of your rights under the Personal Data (Privacy) Ordinance.

2. Personal information is provided by you as an applicant through the completion of application forms designated for various purposes, e.g. for admission to a programme of study, for an exchange programme, for hall admissions, and for provision of facilities or services. Data collected are used specifically for the purposes prescribed in the application forms and will serve

a) as a basis for selection of applicants;

b) as evidence for verification of the applicant’s examination results, academic records and other information; and

c) where applicable, as part of the applicant’s official student records.

In the case of (c) above, information so incorporated into student files will be used for all purposes relating to the student’s studies as required by the relevant regulations and procedures of the University.

3. Personal data will be kept confidential and handled by the University’s staff members. The University may transfer some of the data to an agent or other persons appointed to undertake some of its academic and administrative functions.

4. Under the provisions of the Ordinance, you have the right to request the University to ascertain whether it holds your personal data, to be given a copy, and to apply for correction of the data, if deemed incorrect.

5. Applications for access to and correction of personal data should be made by using a special request form and on payment of a fee. Such applications as well as requests for information should be addressed to the Data Protection Officer, Registry, The University of Hong Kong.

Declaration

1. I have noted the general points pursuant to the Personal Data (Privacy) Ordinance.

2. I authorize the University of Hong Kong to use, check and process my data as required for my application. I accept that all the data in this form and those the University is authorized to obtain will be used for purposes related to the processing and administration of my application in the university context.

3. I authorize The University of Hong Kong to obtain, and the relevant examination authorities, assessment bodies or academic institutions in Hong Kong and elsewhere to release, any and all information about my public examination results, records of studies or professional qualifications, I also authorize the University to use my data in this form for the purpose of obtaining such information.

4. I understand that upon successful application, my data will become a part of my student record and may be used for all purposes as prescribed under relevant rules and regulations as well as attendant procedures, so long as I remain student of this University.

5. I declare that the information given in support of this application is accurate and complete. I understand that any misrepresentation will disqualify my application.

Signature

Name

Date

DN002/2009



Transcript Request Form

I. To the Applicant: Applicant who did not attach their original official transcript should complete the first part of this form and send it to the appropriate officer of institute from which the transcript is requested.

Name of Applicant: ( )in English in Chinese, if any

University/College Attended:

Dates of Attendance: From To

Title of Degree/Diploma: Date of Award:

Programme applied for admission at The University of Hong Kong:

Doctor of Nursing (DNurs) in Department of Nursing Studies

II. To the Officer responsible for issuing transcripts: The applicant named above has applied for admission to a postgraduate curriculum at The University of Hong Kong. Please send one copy of the official transcript together with this form directly to:

DNurs Programme AdministratorDepartment of Nursing StudiesThe University of Hong Kong4/F, William M.W. Mong Block21 Sassoon RoadPokfulam, Hong Kong

DN003/2009



Academic Referee’s Report

Note to applicant:Applicants should complete Section I below, then send one copy of this form to each of two referees with the request that the referee should complete Section II and return the form directly to DNurs Programme Administrator, Department of Nursing Studies, The University of Hong Kong, 4/F William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong before the application deadline either by post, or by fax to (852) 2872-6079. Alternatively, the referee may return the completed report to applicant in a signed and sealed envelope, and the applicant can send the unopened envelope together with the application documents.

Note to referee:The applicant named below is applying for admission to the degree programme indicated. Kindly complete Section II of this report and return it directly to DNurs Programme Administrator, Department of Nursing Studies, The University of Hong Kong, 4/F William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong before the application deadline either by post, or by fax to (852) 2872-6079. Alternatively, you may return the completed report to the applicant in a signed and sealed envelope. All information given here will be treated as strictly confidential. It will be used only for the purpose of determining whether the candidate will be admitted; and it will be accessible only to those responsible for processing the application. The reference will be destroyed after that decision has been made. The University will be most grateful for your full and candid assessment.

Section I (to be completed by the applicant)

Name of applicant (surname):(given name):

Programme applied for: Doctor of Nursing in the Department of Nursing Studies

Section II (to be completed by the referee)

1. How long have you known the applicant?

In what capacity have you known the applicant?

2. How would you rate the applicant’s ability to carry out graduate work at the level applied for?(Please tick as appropriate)

Excellent Good Adequate Less than adequate

No basis for judgement

Powers of analysis and reasoning

Imagination and originality

Motivation

Breadth of knowledge

Skills of writing and argumentation

Capacity for independent work

Intellectual ability overall

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3. Compared with other students you have taught, how would you rate the applicant’s intellectual achievement?(Please tick as appropriate)

Top 10% Next 20% Next 40% Next 20% Bottom 10%

4. Please make any further comments as appropriate (e.g. on the research proposal/statement of research interest).

5. What is your overall recommendation?

Recommend enthusiasticallyRecommend stronglyRecommendRecommend with reservationDo not recommend

Signature of referees: Date:

Title of referee: Professor Dr. Mr. Miss Ms. Mrs.

Name of referee:

Contact Tel No.:Email address:

Address of referee:

Please return this form to DNurs Programme Administrator, Department of Nursing Studies, The University of Hong Kong, 4/F William M.W. Mong, 21 Sassoon Road, Pokfulam, Hong Kong as soon as possible.

May 2009

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DN003/2009



Academic Referee’s Report

Note to applicant:Applicants should complete Section I below, then send one copy of this form to each of two referees with the request that the referee should complete Section II and return the form directly to DNurs Programme Administrator, Department of Nursing Studies, The University of Hong Kong, 4/F William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong before the application deadline either by post, or by fax to (852) 2872-6079. Alternatively, the referee may return the completed report to applicant in a signed and sealed envelope, and the applicant can send the unopened envelope together with the application documents.

Note to referee:The applicant named below is applying for admission to the degree programme indicated. Kindly complete Section II of this report and return it directly to DNurs Programme Administrator, Department of Nursing Studies, The University of Hong Kong, 4/F William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong before the application deadline either by post, or by fax to (852) 2872-6079. Alternatively, you may return the completed report to the applicant in a signed and sealed envelope. All information given here will be treated as strictly confidential. It will be used only for the purpose of determining whether the candidate will be admitted; and it will be accessible only to those responsible for processing the application. The reference will be destroyed after that decision has been made. The University will be most grateful for your full and candid assessment.

Section I (to be completed by the applicant)

Name of applicant (surname):(given name):

Programme applied for: Doctor of Nursing in the Department of Nursing Studies

Section II (to be completed by the referee)

1. How long have you known the applicant?

In what capacity have you known the applicant?

2. How would you rate the applicant’s ability to carry out graduate work at the level applied for?(Please tick as appropriate)

Excellent Good Adequate Less than adequate

No basis for judgement

Powers of analysis and reasoning

Imagination and originality

Motivation

Breadth of knowledge

Skills of writing and argumentation

Capacity for independent work

Intellectual ability overall

- 1 -

3. Compared with other students you have taught, how would you rate the applicant’s intellectual achievement?(Please tick as appropriate)

Top 10% Next 20% Next 40% Next 20% Bottom 10%

4. Please make any further comments as appropriate (e.g. on the research proposal/statement of research interest).

5. What is your overall recommendation?

Recommend enthusiasticallyRecommend stronglyRecommendRecommend with reservationDo not recommend

Signature of referees: Date:

Title of referee: Professor Dr. Mr. Miss Ms. Mrs.

Name of referee:

Contact Tel No.:Email address:

Address of referee:

Please return this form to DNurs Programme Administrator, Department of Nursing Studies, The University of Hong Kong, 4/F William M.W. Mong, 21 Sassoon Road, Pokfulam, Hong Kong as soon as possible.

May 2009

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DN004/2009THE UNIVERSITY OF HONG KONG

LI KA SHING FACULTY OF MEDICINEDEPARTMENT OF NURSING STUDIES


Statement of Proposed Research Area

This 2,000-word Statement of Proposed Research Area in single-space should be about 4 pages.

Applicant Name:

Proposed Topic / Title of Research:

If you wish to receive an acknowledgement of your application, please write your name and address and affix stamp at the bottom of this page.



Dear Sir / Madam,

Your application for admission has been received and is under our consideration. Your application number is . Please quote it whenever you make any enquiries concerning your application.

Normally, you will be notified of the result of your application around six weeks after the application deadline. If you do not hear from us by then, please contact us at [email protected]. Should you have any enquiries, please contact us at [email protected].

Department of Nursing StudiesThe University of Hong KongDate:

DNurs Programme AdministratorDepartment of Nursing StudiesThe University of Hong Kong4/F, William M.W. Mong Block21 Sassoon RoadPokfulam, Hong Kong

Name:

Address:

Pleaseaffix

stamp



341/1106

THE UNIVERSITY OF HONG KONG

Finance and Enterprises Office

Instruction for Application Fee Payment for Taught Postgraduate Programmes

1. The application fee for each postgraduate curriculum is HK$300 (non-refundable).

2. Methods of payment:(You are advised NOT to make payment through bank counter.)

(a) Local applicants residing in Hong Kong

via Automatic Teller Machine (ATM): (Please do not use the “Account Transfer” function for payment.)

- by “Bill Payment” function at ATMs of the HSBC/HangSeng or JETCO bank groups with “Bill Payment Service” or “JET payment Service” logo respectively.

- Select “Bill Payment” → “Education”→ “The University of Hong Kong”- Enter Bill Type “06” Other Fees- Enter Bill account number:

for HSBC/Hang Seng Bank: 20999999834001for JETCO: 2099999983000004001

- Enter payment HK$300

via HSBC Cheque Deposit Machine (CQM):- Make a crossed cheque payable to “The University of Hong Kong”;- Deposit the cheque at any HSBC’s CQM by entering the University of

Hong Kong’s bank account number: 002-222834-002 and the cheque amount of HK$300; and select “Reference” option and entering the reference number: 20999999834001

- Insert the cheque into the cheque insertion slot[please refer to the instructions listed on the machine]

It is essential that the original ATM transaction/cheque deposit advice must be stapled together with your application(s). You are also reminded to retain a photocopy of the transaction/deposit advice as your proof of payment of the application fee.

(b) Overseas applicants not residing in Hong Kong should pay by:

(i) Hong Kong dollar bank draft (HK$300) drawn on a bank in Hong Kong and made payable to “The University of Hong Kong” or

(ii) US dollar bank draft (USD40) and made payable to “The University of Hong Kong”. Personal cheque in foreign currency will NOT be

accepted.

(c) Applicants who wish to apply via the taught postgraduate on-line application system are required to pay the application fee by credit card on-line.

3. Please write your full name and proposed programme of study on the back of the ATM transaction/cheque deposit advice, crossed cheque or the bank draft for identification purpose.

4. Cash will NOT be accepted.

November 2006