Unison Hong Kong for Ethnic Equality

Flat 1303, Wang Yip Building, 1 Elm Street Hong Kong Unison Limited Tai Kok Tsui, Kowloon 香港融樂會有限公司 tel 27893246|fax 27891767 www.unison.org.hk|email:[email protected]

CONFIDENTIAL

2017-18 APPLICATION FORM - TERTIARY EDUCATION SCHOLARSHIP 1. This application form should be completed and postmarked or submitted in person to Unison on or before 5 PM, Friday, 1 September 2017

2. Chinese and oversea students are not eligible to apply

3. All 4 pages must be fully completed. State ‘N/A’ for sections/areas that do not apply to you. Delete where applicable. A photo taken SECTION 1 – PERSONAL INFORMATION within last 2 Salutation: Mr/Mrs/Miss Last name: ______years First Name: Chinese name: ______(if any) Gender: Male/Female Race/Ethnic Origin: ______Date of Birth (dd/mm/yyyy): _____/______/______Place of Birth: ______Number of years resided in HK: ______HKID Card No: ______Address: ______Contact Tel: ______Home Tel: ______Email address: ______

SECTION 2 – EDUCATION Programme currently in/will enroll in Sept 2017 ______Year______Institution/College/University: ______Programme Duration: years, from (mm/yy) / to / Annual tuition fee: HKD per year

A) EDUCATION HISTORY (in chronological order) Dates (mm/yy) School(s) attended (Tertiary/Secondary/Primary) Education level From To (e.g. U1; F1 to F6; P3 to P6) / / / / / / / /

B) PUBLIC EXAMINATION RESULT HKDSE / A-Level Subjects Grade HKCEE Subjects Grade Exam year: ______Obtained Exam year: ______Obtained

1/4 Flat 1303, Wang Yip Building, 1 Elm Street Hong Kong Unison Limited Tai Kok Tsui, Kowloon 香港融樂會有限公司 tel 27893246|fax 27891767 www.unison.org.hk|email:[email protected]

Note: Please attach copies of HKDSE / A-Level / HKCEE Result Certificates

C) OTHER QUALIFICATIONS (e.g. GCE, GCSE) Qualification Obtained Year Attained Level Issued by

Note: Please attach copies of relevant certificates

SECTION 3 – EXTRA CURRICULAR ACTIVITIES/ COMMUNITY AND SCHOOL PARTICIPATION A) SOCIETIES/CLUBS/ORGANIZATIONS/COMMUNITY SERVICE – most recent 2 years only Society/Club/Organization Position Held Participation Activities conducted/ Period participated

B) SPORTS – most recent 2 years only Sport Level Represented (School Participation Awards (if any) /District/Team/Others) Period

SECTION 4 – EMPLOYMENT HISTORY Name of Employer Dates Employed Position Held Hours per Salary per Week Week/Month to to to to to

SECTION 5 – FINANCIAL INFORMATION (If you are shortlisted, you will be required to show relevant documents to verify the information in this section.) PERSONAL FINANCIAL INCOME HKD per month Income (e.g. part-time job if any) Loan/Credit (______) Savings (please state total savings to finance your education) Scholarship (Name: ______) Parental/family/other contribution Others, please specify: ______Total $

A) Will/Have you applied for Government Grant and Loan for 2017-18 academic year? Yes/ No B) Please also check either of the following boxes:  Awarded in 2016-17 academic year: Grant $ ______Loan $ ______

 Awarded in 2017-18 academic year: Grant $ ______Loan $ ______ Rejected because of ______ Unsuccessful because financial conditions did not satisfy requirements or ______ Did not apply or other reasons, please specify: ______C) Have you applied for the Non-means Tested Loan Scheme (NLS) in 2017-18 academic year? Yes/ No | If yes, please state the loan amount received: ______D) Have you received any University Bursaries/Loans in 2017-18 academic year? Yes/ No If yes, please state amount received: Bursary $______Loan $______

E) Family Financial Information Relationship with Age Marital CSSA(HKD$ School/employer Salary (HKD$ Education applicant status per month) per month) level/occupation

Do you own/rent a flat? Own/ Rent If own, outstanding mortgage per month:HKD ______If rent, public housing/private flat/sub-divided flat/squatter |Rental per month: HKD ______

SECTION 6 – LIFE GOALS Please indicate your life goals and education plan to illustrate how the scholarship will facilitate your future development. Please use separate sheet, if necessary.

1) What are your life goals? ______2) What is your education plan? ______3) How will this scholarship facilitate your education plan and life goals? ______

______

SECTION 7 – ADDITIONAL INFORMATION 1) Have you previously applied for scholarships from Unison or other organization? Year 16/17:  No  Applied  Shortlisted for interview  Awarded by Unison $______/Others $ ______Year 15/16:  No  Applied  Shortlisted for interview  Awarded by Unison $______/Others $ ______Year 14/15:  No  Applied  Shortlisted for interview  Awarded by Unison $______/Others $ ______

2) Please provide further information to explain why you are eligible for the scholarship (e.g. financial situation and life goals). ______

SECTION 8 – REFERENCE (MUST fill in this part) Name of Referee*: ______Organization/ School: ______Position held: ______Contact No.: ______Email: ______Office Address: ______

* We may contact your referee for further information on your application. *Any Unison staff, board members or panel judges are not eligible to be a referee.

SECTION 9 – DOCUMENTS CHECKLIST  HKID card  Public Exam Cert  Other Qualification Cert  College Transcript  Photo  Enrolled course documents

SECTION 10 – DECLARATION ALL APPLICANTS SHOULD SIGN AND RETURN THIS DECLARATION WITH THEIR APPLICATION.

I, ______do hereby certify that all statements made in this application are true and complete to the best of my knowledge and have not withheld any information which might influence the consideration of this application. I understand that any misrepresentation, false declaration or omission will be sufficient cause for cancellation of 6/4 Flat 1303, Wang Yip Building, 1 Elm Street Hong Kong Unison Limited Tai Kok Tsui, Kowloon 香港融樂會有限公司 tel 27893246|fax 27891767 www.unison.org.hk|email:[email protected] consideration for scholarship.

If I, ______am a recipient of any Scholarships administrated by Hong Kong Unison Ltd, I authorize Unison to release my information regarding this award through words, photos, interviews etc to donor and the local and overseas mass media.

______Applicant’s Signature Date

FOR OFFICE USE

Eligible Not Eligible