Office of Student Affairs

No. THE CHINESE UNIVERSITY OF HONG KONG Office of Admissions and Financial Aid The Daiwa Bank Group Awards 2015/16

APPLICATION FORM

(i) The application should be TYPED in English and SIGNED. (ii) The information provided will be used for Scholarships / Awards-related purposes in the University. It may be accessible to offices, committees or persons who will process Scholarships / Awards matters. Information on unsuccessful candidates will be destroyed when no longer required. (iii) Completed application forms together with all the supporting documents (please refer to the "Checklist of Supporting Documents" for details) should be submitted IN PERSON to the Scholarships and Financial Aid Section, Office of Admissions and Financial Aid, Room 1202, 12/F, Yasumoto International Academic Park, The Chinese University of Hong Kong during office hours (Monday – Friday 8:45 am – 1:00 pm and 2:00 pm – 5:30 pm except Public Holidays) on or before 10 June 2015.

1. Personal Particulars Name (English) (Chinese) Sex Date of Birth Place of Birth RECENT Nationality Citizenship(s) PHOTO College CUHK Student No. Major @ Minor

Length of Study (Yrs) Current Yr of Study Expected Graduation in ^ / (MM/YY) Home Address

Tel. No. / / / (Home) (Hostel) (Mobile) (Others (if any)) Email (CUHK) (Personal) @ Please type the full programme title, e.g. BA in Japanese Studies, BSc in Quantitative Finance. ^ Please follow the expected graduation date printed on your student card.

2. Academic Results at This University

Year GPA # : Yr 11/12 Yr 12/13 Yr 13/14 Yr 14/15 # Summer term results should be excluded.

Japanese Language Ability Listening Excellent Very Good Good Fair Reading Excellent Very Good Good Fair Speaking Excellent Very Good Good Fair Writing Excellent Very Good Good Fair

- 1 - 3. Details of Awards Received So Far at This University Academic Year Name of Award Amount

4. Extra-Curricular Activities/ Community Services From To Student Organization/Community Activities Post/Contribution (mm/yyyy) (mm/yyyy)

5. Employment Experience Year Name of Company/Employer Post Full-Time/Part-Time

6. Proposed Japanese Studies/ Japanese Language Courses/ Home-Stay Programme in Japan

I have applied for the Full-Year Course on Japanese Studies/ Full-Year Cultural Exchange Programme/ Japanese Language Courses/ Home-Stay Programme * in Japan organized by CUHK for the academic year 2015/16 through:

 College  Department  Faculty  OAL  Others (please specify)

University/ Institution at Japan: City: Period: From To (DD/MM/YYYY) (DD/MM/YYYY) Field of Study to be Specialized in Japan: * Please cross out whichever is inappropriate.

Application status:  Successful  Pending for result (Result is expected to be released on )  Others (please specify)

- 2 - 7. Reasons for Specializing in the Above Field of Study Described in Part 6 (Use separate sheet if necessary.)

8. Future Career Plan

- 3 - 9. Experience of Your Stay in Japan, if any Period / Duration of Stay in Japan Purpose of Visit

10. Details of Scholarships, Awards, Grants and/or Financial Aid for the Full-Year Japanese Studies, Cultural Exchange Programme, Japanese Language Courses or Home-Stay Programme in Japan for the Academic Year 2015/16 So Far Applied For or Received

Name of Award / Financial Aid Amount Date (MM/YY)

Applied for/ Received * in /

Applied for/ Received * in / * Please cross out whichever is inappropriate.

11. Authorization 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 Daiwa Bank Group Awards 2015/16.

I also undertake to inform OAFA as soon as practicable of any scholarships/ awards/ grants/ financial aid conferred to me for the full-year Japanese studies, Cultural Exchange Programme, Japanese language courses or home-stay programme in Japan for the academic year 2015/16 after submission of this application.

I understand that the University reserves the right to withdraw The Daiwa Bank Group Award offered to me or deduct the award amount should I be granted scholarships and/or financial aid from other sources.

Signature of Applicant : Date :

Note: All the data provided by the applicants should only be used for the purposes related to the application/award of this scholarship. Data users must comply with the requirements of the HKSAR Personal Data (Privacy) Ordinance.

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

The Daiwa Bank Group Awards 2015/16 Confidential Reference

The person named below is applying for The Daiwa Bank Group Awards. Please comment by completing BOTH Parts B and C of this form and continuing on a separate sheet, if necessary, on the applicant's other attributes which are relevant to this application for the proposed programme. The applicant will submit the completed application together with all the supporting documents, including this confidential reference, to the Scholarships and Financial Aid Section, Office of Admissions and Financial Aid, The Chinese University of Hong Kong not later than 10 June 2015. Please place this confidential reference in an envelope and sign across the sealed envelope flap before returning it to the applicant for submission.

A. To be completed by applicant ( * Please cross out whichever is inapplicable. )

Applicant's name in full (Surname) (Given Name) Full-Year Course on Japanese Studies / Full-Year Cultural Exchange Proposed Programme Programme / Japanese Language Course / Home-Stay Programme * Name of referee (Surname) (Given Name)

B. To be completed by referee 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, and provide additional comments in the space provided at the back of this form.

Excellent Good Satisfactory Intellectual ability Analytical power Creativity Leadership Communication skills All-roundedness Commitment to Hong Kong Language proficiency 1. Chinese 2. English 3. Others (if any)

- 1 - C. Other comments on the applicant

Name Signature

Position Department

Date Institution

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

The Daiwa Bank Group Awards 2015/16

Checklist of Supporting Documents

(i) Completed application forms together with the following documents should be submitted IN PERSON to the Scholarships and Financial Aid Section, Office of Admissions and Financial Aid, Room 1202, 12/F, Yasumoto International Academic Park during office hours (Monday – Friday 8:45 am – 1:00 pm and 2:00 pm – 5:30 pm except Public Holidays) on or before 10 June 2015.

(ii) ALL copies of the supporting documents must be in A4 size white papers and in the following order; AND you have:

completed ALL parts of the Application Form. If the item(s) is/are not applicable, "N.A." should be marked.

one confidential reference from a teacher of applicant's Major Department of this University. Please request your referee to place the confidential reference in an envelope, sign across the sealed flap, and return it to you for submission to the Scholarships and Financial Aid Section, Office of Admissions and Financial Aid before the application deadline.

photocopies of the Japanese-Language Proficiency Test/TOEFL/IELTS score transcript with Explanation Notes of Grading System, i.e. copies of both sides of the score transcript (if any).

a copy of academic transcripts with Explanation Notes of Grading System from Undergraduate Year 1 to the latest term (i.e. Term 2, 2014/15), including those related to Exchange Programme (if any). A copy of academic transcript downloaded from Chinese University Student Information System (CUSIS) is acceptable.

proofs on identity of minor student of Japanese Studies#, e.g. a copy of Minor Declaration Form approved by the Department of Japanese Studies.

# Minor programmes offered by the Department of Japanese Studies include Japanese Language, Japanese Studies, Japanese Culture, Japanese Language & Culture, and Japanese Language & Linguistics.