2013 scholarship form
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Centaline Charity Fund Scholarship
Application Form2013/2014
A. Personal Information Chinese Name English Name () (Fill in block
letters)
HKID card no. 1 Date of Birth (YYYY/MM/DD)
Place of Birth Gender
Residential Address () (Fill in block letters)
Type of accommodation
Private Property Housing Ownership Scheme
(HOS)
Public Housing
Housing ownership
Self-owned Rented
Others, please specify:
Accommodation expenses Mortgage payment
( ) Monthly(HKD)
___________________________
Rent
( ) Monthly(HKD)
_________________________
Not Applicable
Home Phone Mobile Phone
Email Address
Personal Account Info (Applicant must be the only owner of the account. Deposit account, credit card account
or foreign currency account will not be accepted.)
Name of Bank ______________________________________________
Account Name ______________________________________________
Account Number ______________________________________________
Reasons for applying for the application (Please check all that are applicable)
Support tuition
costs
Support cost of
materials
Support medical
expenses
Support living
expenses
Others, please
specify:
1
Photo
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Proposed future occupation in Hong Kong
B. () Family members (Guardian, Parents and Siblings)
Name
Relationship
to applicant
Age
/
Occupation/
Grade
Type of position
FT/ PT
Monthly Salary
Yes/
No
Contact
No.
1.
2.
3.
4.
5.
6.
7.
8.
C. Family Status Family subvention situation
CSSA
() Monthly(HKD) _________
Disability Allowance
() Monthly(HKD) _________
() Old Age Allowance
() Monthly(HKD) __________
/Retirement
benefits/Pensions
() Monthly(HKD) _________
Contributions from relatives
and friends
() Monthly(HKD) _________
Old Age Living
Allowance
() Monthly(HKD) __________
Others, please specify:_______________________________________________________________
() Monthly(HKD) __________________________________________________________________________
Parents marital status
Divorced Separated Never Married Widowed
/Members whom you live together who are disabled or chronic patients1.
Name
Relationship
Health Status
2.
Name
Relationship
Health Status
: Other special circumstances and large expenses, please specify:
Any family members who have applied for the Centaline Charity Fund Scholarship?
Yes Name Year of
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Relationship Application Successful Unsuccessful
No
D. 1 University Offers1
Name of
University
College
/
Department/
Faculty
Course of study
/
Expected Starting
Year/Month
()
Total School Fee for
this academic Year
(HKD)
1.
2.
3.
E. () Other Scholarship Applications (Except this scholarshipapplication)
Name of Scholarship
Organization
()
Amount (HKD)
Notification Date
Application Status
//
Successful/
unsuccessful/
unknown1.
2.
3.
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F. Education
Name of School
School Address
School Type
Govt/Aided/
Private/ DSS/
CAPUT
Period of
Study
Grade
1.
2.
3.
4.
5.
G. 1 Pubic examination results in the most recent two academic1
H. 1 Academic transcripts in the most recent two academic years1
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I. 700 You are required to submit a typewritten personal statement of your future goals or career
plans and how will your field of study assist you to achieve your goal and serve the
community in Hong Kong in no more than 700 words.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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J. 1Academic and non-academic awards in the most recent two academic years 1
K. Extra-curricular activities or voluntary services in the most recent two years
Activity
Organization
Nature of Activity
/
Year/Month
2
Position held2
1.
2.
3.
4.
5.
6.
7.
8.
Organization
Name of Award
Date ofCommencement1.
2.
3.
4.
5.
6.
7.
8.
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L. Personal Interest1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
3. ______________________________________________________________________________________________
4. ______________________________________________________________________________________________
5. ______________________________________________________________________________________________
M. 3 Referee 3
Name
Relationship
Name of School
Contact Number
1.
2.
3.
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N. Others()
Sources from which you obtained information about the Centaline Charity Fund Scholarship (check all that apply)
Homepage of Centaline Charity
Fund
/
E-mail/e-notice from university
Relatives and friends
Homepage of Centaline Property
Agency
/
E-mail/e-notice from secondary
school
Others, please specify:
O. Declaration1. 4
2.
3.
1. I am/ am not 4a Hong Kong permanent resident; or
Prior to application, I have resided in Hong Kong continuously for 3 years and my parents or
one of them is a Hong Kong permanent resident.
2. I agree to return the full amount of Centaline Scholarship to Centaline Charity Fund
Limited before the end of that academic year if I am unable to complete/ have to
end the academic programme I am pursuing during that academic year regardless
of the reasons.
3. I thereby declare that the statements made in this application are, to the best of my
belief, true, complete and correct. I agree that Centaline Charity Fund Limited can
contact the above listed organizations or individuals for inquiries regarding my
Scholarship application.
Signature of Applicant
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______________________________
Date (YYYY/MM/DD)
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PS
1 Please provide softcopies of supporting documents.
2Please specify the position as member, group leader or executive committee.
3 Please provide all reference letters by the referees, referees must be school principal, Department Head or Class
Teacher.
4
Please delete the unnecessary choice.
Please attach extra pages if needed.
1. 20138161159 ()
2. PDF10MB [email protected]
3.
a. PDF
b.
c.
d.
e.
f.
4.
5.
6.
7. ()
8.
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Attention
1. The deadline of submission is 16th August, 2013 11:59pm (as indicated by the Centres
server)
2. After completion of application form, please scan in full colour, all pages of the application
with the attached personal statement and softcopies of supporting documents, then save
all documents as one PDF file and compress the file to 10MB and submit it via email to
3. The following applications will not be considered, the Centre will not notify the applicants in
person:
a. Any electronic document that is not in a PDF format
b. Any application that is not submitted via email
c. Any unclear applicationd. Applications with any missing pages or incomplete sessions
e. Applicants who fail to provide other required supporting documents without sufficient reasons
f. Any further documentations or information must be submitted by the deadline indicated by the
Centre
4. All supporting documents or softcopies of reports must be submitted at the end of the
application form according to the sessions in the application form.
5. Shortlisted applicants will be invited to an interview via email within a month after the
deadline of the application. Those who did not receive email notification within a month canconsider their applications unsuccessful.
6. Submitted applications and relevant documents will not be returned once they have been
processed.
7. Any submitted information is protected by the Personal Data (Privacy) Ordinance. The
information will only be used for this application and related statistics.
8. If there is any misreport of information in the applications, the applications may not be
considered/ the awardee will be asked to return the full amount of Scholarship. Please be
noted that any person who by any deception dishonestly obtains for himself or another any
pecuniary advantage shall be guilty of an offence and shall be liable on conviction upon
indictment to imprisonment for 10 years under the Theft Ordinance (Chapter 210 of the
Laws of Hong Kong).
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1.
2.
3. 4.
5.
6.
Checklist for required documentation softcopies
1. Applicants Identity Card
2. Applicants University admission letter
3. Applicants Public Examination Records (the most recent 2 years)
4. Applicants Secondary School Academic Reports (the most recent 2 years)
5. Applicants proofs of any academic and non-academic awards received in the most recent 2 years
6. Reference Letters
Enquiries Centaline Charity Fund Limited Address 18 22
22/F, New World Tower 1, 18 Queens Road Central, Hong Kong
Hours 9 30 1 Mon-Fri 9:30am-6pm
Contact person Ms. Tang
Phone (852) 2501 1505 / (852) 2521 8402
Email for enquiries [email protected]
Email for Application Submission [email protected]
Website www.centacharity.com.hk
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