Jupas Form

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PETeam10a

Serial No. ________


The Hong Kong Polytechnic University
Student Affairs Office
Physical Education Section

Outstanding Sportsmen Recommendation Scheme


Application Form (JUPAS Applicants Only)

Personal Information
Name: ________________________________________________________________________
(English) (Chinese)
E-Mail Address: ________________________________________________________________

Tel No. :_______________________________(Home) ___________________________(Mobile)

Secondary School / College Attended (with year) : ____________________________________


Sports Achievement
Sports Type : ___________________________________________________________________

Sports Performance Level : * ( Pls. tick as appropriate )


□ Hong Kong Team Member □ Hong Kong Junior Squad
□ Inter-school Competition ( Division I / II / III ) * □ School Representative

Awards:__________________________________________ ( Certificates are required )


Application Details
Application No. ____________________
Programme Choice in Band A

Programme Name: __________________________________ Code: _____________

Programme Name: __________________________________ Code: _____________

Please submit this form to PE Section on Saturday, 27 November 2010


from 8:45 am to 1:00pm in Fong Shu Chuen Hall, PolyU

10/2005

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