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李韶暑期計劃 2016
Lee Shiu Summer Programme 2016
NOTE TO APPLICANTS:
This form is designed to solicit information on different aspects of your achievements. Please do not be daunted by its wide
coverage, as you are not required to be outstanding in all aspects in order to be qualified for the Project.
Application form (HKU)
1.
2.
3.
4.
Please complete the form in block letters.
Submission: HKU applicants please submit the form via email to Ms. Celeste Shai at gened@hku.hk.
Please use supplementary sheets if necessary. This form can be downloaded from http://www.cuhk.edu.hk/ccc/lssp/
Enquiry: General Education Unit, HKU (gened@hku.hk / (852)-39175044) or
Chung Chi College, The Chinese University of Hong Kong ( leeshiu@cuhk.edu.hk / (852)-39439236)
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Personal Particulars
Name (English)
(Chinese)
Gender
Date of Birth
University No.
HKID Card No.
Address
Tel. No. (Home)
(Mobile)
E-mail
(We shall communicate with you on e-mail. Please put down an address that you use frequently.)
Department/ Curriculum
College
Year
(Undergraduate)
Hobbies/ Interests
Languages and Skills (self-assessment) (please give a tick () in the appropriate box)
WRITTEN LANGUAGE
Chinese
□ excellent
□ very good
□ good
□ fair
□ poor
English
□ excellent
□ very good
□ good
□ fair
□ poor
Putonghua
□ excellent
□ very good
□ good
□ fair
□ poor
English
□ excellent
□ very good
□ good
□ fair
□ poor
SPOKEN LANGUAGE
Others
2
Secondary Education (in chronological order)
Date (month/year)
From
To
Public Exam(s)
Secondary School(s)
Subjects and Examination Results
(e.g. GCE, IB, HKDSE,
(Please attach supporting documents)
SAT, ACT, etc.)
Tertiary Education
Date (month/year)
CGPA
(Please attach academic reports)
Curriculum / Current Year
From
To
Academic Achievements
Type
(Scholarship, Academic Distinctions or Others)
Year
Award(s)
Awarded by
Working Experience (including summer jobs & part-time jobs in chronological order)
Date (month/year)
Name of Employer(s)
From
To
Position
Duties / Achievement
3
Extra-Curricular Activities
Date (month/year)
Name of Organization(s)
From
Position
Duties
To
Experience in Social Services or Voluntary Work (in chronological order)
Date (month/year)
Name of Organization(s)
From
Duties / Achievement
To
Referee
(Please provide the name of a lecturer, secondary school teacher or principal who knows you well.
him or her for a reference.)
Name
Position
Department / School
If necessary, we may ask
Contact Number
E-mail Address
4
Personal Statement
Please use the blank space below and explain why you wish to take part in the programme and your
expectations in the Programme. Please also briefly describe and explain your interpretation of “Success in
the Modern World”. You may also provide other information about yourself if necessary. Either Chinese
or English is accepted; ~ 500 to 800 words. Please attach extra pages if needed.
Signature of Applicant:
Date: