GRADUATE SCHOOL
Application for Course(s) Withdrawal

A.	Declaration by Student

Name: __________________________________________	Student No.: __________________________________________

Programme: _____________________________________	Department : _________________________________________

Academic Year: __________________________________	Semester/Trimester: __________________________________

Reason(s) for Withdrawal: 	___________________________________________________________________________________

___________________________________________________________________________________________________________

Applicant's Signature: _____________________________	Date: ________________________________________________

Course(s) applied for Withdrawal:

Course	Section		Course-Instructor		
Code & No.	Lect.	Tut.	Units	Name	Signature	Recommendation	
						 Recommended    Not recommended	
						 Recommended    Not recommended	
						 Recommended    Not recommended	
						 Recommended    Not recommended	

Note: Course approved for withdrawal will be assigned a ‘W’ grade which is not included in GPA calculation.

Total number of units enrolled in this semester after withdrawing from the above course(s):__________ units

B.	Administrative Officer's Approval

	Approved		Not approved

Comments: 	_______________________________________________________________________________________

Signature: __________________________________________	Date: ________________________________________________

For office use		
Application received on:    _____________________		by:  _______________________	
Grade entry on:   ______________________________		by: ___________________	
Letter to student on:  ___________________________	Checked by:  _______________	

Personal Data (Privacy) Ordinance
Personal Information Collection Statement

Persons who supply personal data in their applications to the Graduate School for various purposes are requested to note the following:

1.	Personal data provided in the applications are to facilitate the process of their applications and will not be used for other purposes.
2.	Personal data provided will only be used by University staff.
3.	After the applications have been processed, relevant data will be transferred to the student record system of the University.

Under the provision of the Personal Data (Privacy) Ordinance, request for personal data access or correction may be made and addressed to:

			Graduate School
			AAB 904, Level 9, Academic and Administration Building,
			Baptist University Road Campus,
			Hong Kong Baptist University
			Kowloon Tong
			Kowloon