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The data collected will be kept confidential and used by the Hongkong Bank Foundation to process the scholarship application.
HSBC HONG KONG SCHOLARSHIP 2014/2015
UNIVERSITY RECOMMENDATION
APPLICANTS PERSONAL INFORMATION


Name: Chinese name:
Gender: Birth date: HK I/D card no.:
Place of birth: Years of residency in Hong Kong:
Citizenship(s):
Fathers occupation: Mothers occupation: recent photo here
Family* income: HK$ per month Number of family* members:


Recipient of government loan (Y/N): Amount: HK$


Recipient of government grant /
subsidies / allowances (Y/N):
Amount: HK$


Home address:

Contact number (s):
E-mail address: (school)
(permanent)
Hobbies:

Name of local university: The Chinese University of Hong Kong
Name of degree course: Duration: Years Current year of study: Year
GPA score

Please attach transcript

2014/2015 (1
st
term)

2013/2014 (if applicable)



Summary of rating:


Excellent Good Satisfactory
Intellectual ability


Analytical power
Creativity
Leadership
Communication skills
All-roundedness
Commitment to Hong Kong


* Family is defined as applicant, applicants spouse/parents/siblings/children and any other persons who are financially dependent on the
aforementioned members
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To be completed by the Office of Admissions and Financial Aid
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The data collected will be kept confidential and used by the Hongkong Bank Foundation to process the scholarship application.
ACADEMIC RECORD (continued)

TO BE COMPLETED BY THE APPLICANT
IMPORTANT: PLEASE USE THE SPACE PROVIDED BELOW. ADDITIONAL SHEETS/ATTACHMENTS WILL NOT BE
REVIEWED.
Extra-curricular activities and community service:
(Please list in chronological order.)

Academic Year Student Organization/Activities Post / Contribution














Name of Secondary School(s) attended:
(Please list in chronological order.)
From (MM/YY) To (MM/YY) Name of Secondary School Level Attained



Work experience (full-time and part-time):
(Please list in chronological order.)

From (MM/YY) To (MM/YY) Name of Employer Job Title





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TO BE COMPLETED BY THE APPLICANT (CONTD)
IMPORTANT: PLEASE USE THE SPACE PROVIDED BELOW. ADDITIONAL SHEETS/ATTACHMENTS
WILL NOT BE REVIEWED.

Essay: Please use less than 500 words to share with us one area that Hong Kong can do better.
What can be done to address the need and what will you personally do to lead, facilitate or contribute?



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DECLARATION BY THE APPLICANT

I, , declare that the information provided above is complete and true to the best of my
knowledge. I am aware that the Hongkong Bank Foundation will rely, and consent to the Hongkong Bank Foundation
relying, on the information provided by me to determine the eligibility for the scholarship and the amount of the
scholarship to be offered to me.

I hereby consent, and confirm that each of the family members and other persons in respect of which personal data or
other information (the Information) is provided in or in relation to this application consents, to the Hongkong Bank
Foundation using the Information for the purposes of considering, processing and administering this application and/or
the scholarship granted under this scholarship programme and any purpose directly related to such purposes. I authorise
and consent to my university or institution releasing my personal data held by it to the Hongkong Bank Foundation in
order for it to use such information to consider, process and administer my application and/or the scholarship granted
under this scholarship programme and any purpose directly related to such purposes. I authorise the Hongkong Bank
Foundation to (i) transfer the Information and any of my personal data to The Hongkong and Shanghai Banking
Corporation Limited (HSBC) and for HSBC to use such Information and personal data for the purposes of considering,
processing and administering my application and/or the scholarship granted under this scholarship programme and any
purpose directly related to such purposes; and (ii) release the results of my application to my university or institution.




Signature of the Applicant:
Name in full:
HKID Number:
Date:

R-UGD(Financial Need) No. _________
THE CHINESE UNIVERSITY OF HONG KONG
University Award 2014/15
Resume of Nominee (Undergraduate)

1. The information gathered will be used for Scholarships/Awards-related purposes in the University. It may be accessible to offices, committees
or persons involved in Scholarships/Awards matters. Records of unsuccessful candidates will be destroyed when no longer required.
2. The application formshould be typed in English. If the item(s) in the formis/are not applicable, "N/A" should be marked.

Name of Award

Personal Data

Name CU Student ID No.
(In BLOCK LETTERS, SURNAME FIRST) (In Chinese) (10 digits)
Gender Major / Programme of Study
@

Current Year Expected
Minor College of Study Yr. Graduation in

/ 20 (MM/YYYY)
Date of Place of
Birth / / (DD/MM/YYYY) Birth Citizenship
Home Address
Telephone Mobile
E-mail Address (CUHK) / (Personal)
@
Please type the full programme title, e.g. BA in Fine Arts.

Please follow the expected graduation date printed on your student card.

Admission Channel (Please put a in an appropriate box.)
EAS J UPAS (HKALE) J UPAS (HKDSE) Non-J UPAS (Local)
Mainland Others (Please specify)
Academic Results at this University (in 3 decimal places)
Year Grade Point Average / Rank in Class *: 1
st
Year ^ 2
nd
Year ^ 3
rd
Year ^
4
th
Year ^ 5
th
Year ^
* Please delete whichever is inappropriate. ^ Summer termresults should be excluded.
Awards / Academic Distinctions before the academic year 2014/15
Academic Year Name of Award Amount (HK$)
1.
2.
Awards / Academic Distinctions for the academic year 2014/15
Name of Award Amount (HK$) Status
1.
Awarded / Applied for / Nominated *
in / 20 (MM/YYYY)
2.
Awarded / Applied for / Nominated *
in / 20 (MM/YYYY)

* Please delete whichever is inappropriate.

Extra-curricular Activities
Year Student Organization/Activities Post / Contribution
1.
2.


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Financial Situation of Nominee and Family
No. of Household Members (including nominee):
(Please provide the information on ALL household members living together with you in Table 1 and Table 2.)
Table 1 Monthly Income of Household Members

Relationship Occupation / Monthly
Name Age with Nominee Employment Status
#
Income (HK$)
1. Nominee
2. Father
3. Mother
4.
5.
6.

#
Please specify the occupation if employed. Examples of Employment Status: Student, Housewife, Unemployed, Retired, etc.

Table 2 Other Income
(e.g. pension, public assistance, compensation, financial assistance from relatives and friends, etc.)

Description Monthly Amount (HK$)
1.
2.

Table 3 Financial Assistance Received
(Please mark N/A if it is not applicable, and Pending if the result is not received yet.)

2012/13 (HK$) 2013/14 (HK$) 2014/15 (HK$)
1. Government Grant/Loan / / /
2. University Bursary/Loan / / /

Table 4 Housing (Please put a in an appropriate box.)

Type: Public Housing Private Housing Others (Please specify)
Area of familys living place: m
2
/ sq ft*
Monthly rental payment: HK$
Monthly mortgage payment: HK$
* Please delete whichever is inappropriate.

Declaration and Undertaking

I hereby declare that the information provided in this form is correct and true to the best of my knowledge. I
authorize the Office of Admissions and Financial Aid (OAFA) of The Chinese University of Hong Kong to obtain
any information from other units of the University which OAFA considers necessary and relevant to the
administration and assessment of my application for the captioned Award.

I also undertake to inform OAFA, as soon as practicable, of any awards/scholarships/prizes conferred
to me for the academic year 2014/15 after submission of this form.


Signature of Nominee: Date:


Note: All the data provided by the applicants should only be used for the purposes related to the award of scholarships/
bursaries. Data users must comply with the requirements of the HKSAR Personal Data (Privacy) Ordinance.
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RESTRICTED
The data collected will be kept confidential and used by the Hongkong Bank Foundation to process the scholarship application.

UNIVERSITY RECOMMENDATION (Please use the space provided)









Signature: Date:

(signature with official chop)

Name:
Title:


THE CHINESE UNIVERSITY OF HONG KONG
Office of Admissions and Financial Aid

HSBC Hong Kong Scholarship 2014/15
Confidential Reference




The person named below is applying for a scholarship under HSBC Hong Kong Scholarship. Please complete
Part B of this form on the applicant's other attributes which are relevant to this application.





A. To be completed by applicant
Applicant's name in full (Surname) (Given name)
Name of referee (Surname) (Given name)






B. To be completed by referee (A teaching staff of an applicants major Department)

Please rate the applicant in the context in which you have known him or her by placing a "" under the
rating column which best describes the applicant's character qualifications.

Excellent Good Satisfactory
Intellectual ability
Analytical power
Creativity
Leadership
Communication skills
All-roundedness
Commitment to Hong Kong




Signature of Referee: Date:

Name of Referee:
J ob Title / Position: