USTH Application form for Bachelor course intake 2012

Trng i hc Khoa hc v Cng ngh H Ni Mu n ng k d tuyn nm hc 2012

UNIVERSITY OF SCIENCE AND TECHNOLOGY OF HANOI

TRNG I HC KHOA HC V CNG NGH H NI
Application Form For Bachelor Course Intake 2012

PHOTO
nh 4x6

n ng k d tuyn H c nhn nm hc 2012

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APPLICANT INFORMATION / THNG TIN C NHN
Full Name / H v tn: ..................................................................................................................................................
Gender / Gii tnh:

Male / Nam

Female / N

Date of Birth / Sinh ngy: ..................................................... Place of Birth / Ni sinh:......................................................

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Nationality / Quc tch: .....................................................................................................................................................
Mailing Address for correspondence / a ch gi th: .................................................................................................
House number and street / S nh, ng: ..................................................................................................................
.......................................................................................................................................................................................
City / Thnh ph: ............................................................................................ Post code / M bu in: ....................
Country / Quc gia: ......................................................................................................................................................
Telephone / in thoi: ........................................................................ Fax: .........................................................
E-mail: ..........................................................................................................................................................................
Marital Status / Tnh trng hn nhn:

Single/c thn

Married/ Kt hn

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APPLICATION INFORMATION / NI DUNG D TUYN
Course / Kha hc: BACHELOR IN SCIENCE AND TECHNOLOGY / C NHN KHOA HC V CNG NGH
Specialty / Chuyn ngnh:
o Biotechnology Pharmacology

Cng ngh sinh hoc Dc hoc

Technology

o Materials Science - Nanotechnology

Khoa hoc cng ngh thng tin Truyn thng

Khoa hoc vt liu Cng ngh Nano

o Water Environment - Oceanography

Nng lng
o

Nc Mi trng Hai dng hoc

Information and Communication

Energy
Aeronautics - Space

Hang khng Khng gian vu tru

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Academic results / Kt qu xp loi hc tp PTTH:

Grade 10 / Lp 10:

Advanced / Cao cp

Grade 11 / Lp 11: .

Intermediate / Trung cp

Grade 12 / Lp 121: ....

Beginner / S cp

High school graduation result / Kt qu tt nghip

1

English level / Trnh ting Anh:

Certificate in English / Chng ch ting Anh:

If the average for Grade 12 hasnt been released, please mention the average marks of the 1st semester of Grade 12.
Nu cha c im trung bnh nm lp 12, vui lng in im trung bnh hc k 1 nm lp 12.

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USTH Application form for Bachelor course intake 2012

Trng i hc Khoa hc v Cng ngh H Ni Mu n ng k d tuyn nm hc 2012
PTTH:

.
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HIGH SCHOOL OR EQUIVALENT/QU TRNH HC TP TI BC TRUNG HC PH THNG HOC TNG
NG
Institution Name / Tn trng: ......................................................................................................................................
Complete Address / a ch y : .................................................................................................................................
.........................................................................................................................................................................................
Telephone / in thoi: ................................................................. Fax: ..........................................................................
Class / Lp: .....................................................................................................................................................................
Head teacher / Gio vin Ch nhim: ..............................................................................................................................
Telephone or email / S in thoi hoc email: ............................................................................................................
Marks
im s
(theo Hc b)
Average for Grade 10
im trung bnh nm
lp 10
Average for Grade 11
im trung bnh nm
lp 11
Average for Grade 12
im trung bnh nm
lp 122

Mathematics
Ton

Physics
Vt l

Chemistry
Ha hc

Biology
Sinh hc

ICT
Tin hc

Foreign
language
Ngoi ng

Prizes and distinctions / Cc thnh tch ni bt (hc bng, gii thng ):

......................................................................................................................................................................................
......................................................................................................................................................................................
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Issue date of High school diploma / Thi gian cp bng tt nghip: .....

Expected / D kin3

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LANGUAGE SKILLS / KH NNG NGOI NG
Your level of competence in foreign languages / Kh nng ngoi ng:
Advanced
Cao cp

Intermediate
Trung cp

Beginner
S cp

None
Khng

English
Ting Anh
French
Ting Php
Vietnamese
Ting Vit
Certificates (if any) / Chng ch (nu c):
If the average for Grade 12 hasnt been released, please clearly mention the average marks of the 1st semester of Grade 12.
Nu cha c im trung bnh nm lp 12, vui lng in v ghi r im trung bnh hc k 1 nm lp 12.
3 Please check if High school diploma has not been granted yet / Vui lng nh du vo D kin nu Bng tt nghip cha
c cp
2

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USTH Application form for Bachelor course intake 2012

Trng i hc Khoa hc v Cng ngh H Ni Mu n ng k d tuyn nm hc 2012
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USTH Application form for Bachelor course intake 2012

Trng i hc Khoa hc v Cng ngh H Ni Mu n ng k d tuyn nm hc 2012
STATEMENT OF MOTIVATION / TRNH BY MC CH, NGUYN VNG
Explain within 300 words the purpose of your application and your reasons for applying to USTH, detailing your
career objectives and the reason for which you choose the above-mentioned specialty, etc. preferably in English /
Trnh by trong vng 300 t mc ch v l do ng k d tuyn vo Trng HKHCNHN, mc tiu ngh nghip v
l do chn ngnh, vv. bng ting Anh.

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FINANCIAL AID APPLICATION / H TR TI CHNH
Application for need-based financial aid for: / Xin h tr ti chnh cho cc trng hp:

o Children of invalids, war invalids

o Coming from family with low income

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USTH Application form for Bachelor course intake 2012

Trng i hc Khoa hc v Cng ngh H Ni Mu n ng k d tuyn nm hc 2012
Con thng bnh binh
o Coming from remote rural areas
n t vng su vng xa, nng thn

Gia nh hon cnh kh khn

o Other: .....................................................
Khc: .....................................................

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USTH Application form for Bachelor course intake 2012

Trng i hc Khoa hc v Cng ngh H Ni Mu n ng k d tuyn nm hc 2012
The application file should include the following documents/ H s cn np bao gm:

This application form duly filled, dated and signed

Mu n d tuyn in y , ghi r ngy thng v k xc nhn

High school diploma, certificate or equivalent (compulsory if available)

Bng tt nghip THPT, giy Chng nhn tt nghip tm thi hoc tng ng (bt buc nu c)

High school record

Hc b THPT hoc tng ng (cng chng)

International certificates of foreign languages (IELTS, TOEFL, DELF, DALF or other), letters of

recommendations (if any)

Chng ch ngoi ng quc t (IELTS, TOEFL, DELF, DALF, hoc chng ch khc), th gii thiu (nu c)
o

Supporting documents for financial aid application (e.g. certificates for prizes and distinctions,

attestation of invalidity of parents, attestation of family circumstance, etc. if any)

Cc ti liu chng minh trong trng hp ng k h tr ti chnh (v d chng nhn cc gii thng, thnh
tch xut sc, chng nhn con thng binh, bnh binh, chng nhn hoc cnh gia nh, v.v. nu c)
___________________________________________________________________________________________
Applicants declaration/ Cam kt ca ng vin
I certify that the information contained in this
application is accurate and complete.

Ti cam oan rng ton b thng tin trong bn ng

k ny l hon ton chnh xc v y .

Please note that the USTH reserves the right to

refuse admission or to terminate a students
attendance should it be discovered that he/she has
made a false statement or has omitted significant
information.
If you are selected, you will be required to provide
evidence proof of your qualifications.

Xin lu rng HKHCNHN hon ton c quyn t

chi khng cho sinh vin nhp hc hoc chm dt
vic hc tp ca sinh vin nu pht hin anh/ch cung
cp thng tin khng chnh xc hoc thiu st.
Nu c trng tuyn, th sinh s bt buc phi cung
cp y cc h s yu cu.

Signature and full name/ K v ghi r h tn: __________________________________________________

Place and date/ a im v ngy thng: _____________________________________________________

Filled application form under MS Word or PDF format to be mailed to/ Mu n ng k d

tuyn in y gi bn in t (MS Word hoc PDF) v a ch email
admission@usth.edu.vn
Application file to be sent by post to / H s ng k d tuyn gi v a ch gi th:
TRNG I HC KHOA HC V CNG NGH H NI (USTH)
Address / a ch : Nh 2H, 18 Hong Quc Vit, Cu Giy, H Ni - Tel / T : +84-3791 6960
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USTH Application form for Bachelor course intake 2012

Trng i hc Khoa hc v Cng ngh H Ni Mu n ng k d tuyn nm hc 2012

Application deadline/ Hn np : 31/8/2012 (t 3)

Incomplete applications will not be considered/ Cc h s khng y s khng c xem xt.

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