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

For internal use onlyApplication No.


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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


() Old Age Allowance

() Monthly(HKD) __________

/Retirement

benefits/Pensions


Contributions from relatives

and friends


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

2


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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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1

2

3

4

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.

210 10

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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

[email protected].

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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2013 scholarship form

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