Hong Kong Baptist University

Language Centre

Awards for Outstanding Performance in the IELTS Test (2015-16)

Application Form

(Deadline for application: 31 July 2016)

The information provided in this form will be used solely for implementing the scheme of the Awards for Outstanding Performance in the IELTS Test.

A. Personal Information

Full Name:
Student No:
Faculty/School: / Major :
Year of Graduation: / Cumulative GPA (Optional):
Email: (HKBU Email): / (Other Email):
Contact Phone No:

B. IELTS Results (Obtained between 1 June 2015 – 31 May 2016)

Tests / Results
Listening
Reading
Writing
Speaking
IELTS Overall Band
Test Date(s)

C. IELTS Preparation Courses Taken at HKBU Language Centre before taking the IELTS Test(s) (having fulfilled the attendance requirements in at least 15 hours of course(s))

Please tick ü the appropriate box(es).

Course Title / Course Code / No. of Course Hours
q / IELTS Prep Course (Speaking & Listening) / SUPE 2240
q / IELTS Prep Course (Reading & Writing) / SUPE 2290
q / Intensive IELTS Prep Course (Speaking Listening) / SUPE 2241
q / Intensive IELTS Prep Course (Reading & Writing) / SUPE 2291
q / Intensive IELTS Prep Course (Speaking) / SUPE 2242
q / Intensive IELTS Prep Course (Writing-Task 1) / SUPE 2293
q / Intensive IELTS Prep Course (Writing-Task 2) / SUPE 2292
q / Others______
Total No. of Hours:

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D. Collection of Awards

Awardees will be notified by email in October 2016 and invited to collect their award(s) between October and November 2016 (in person from the Language Centre). Your Student ID Card will need to be presented when collecting the award(s).

E. Declaration

1. / I am a final-year UGC-funded HKBU undergraduate student who have taken the IELTS test(s) between 1 June 2015 and 31 May 2016.
2. / I have achieved at least a score of 7.5 in the Speaking and/or Writing component(s) of the IELTS test(s).
3. / I have fulfilled the attendance requirements in at least 15 hours of IELTS Preparation course(s) offered by HKBU Language Centre before taking the IELTS test(s).

Applicant’s Signature: ______Date: ______

IMPORTANT NOTE:

Please remember to bring your original IELTS Test Report(s), your Student ID Card, and the completed application form to the Language Centre (Rm OEE1203, Oen Hall Building, HSH Campus) in person during office hours (Mon – Fri 9:00-13:00 & 14:00-17:30; & Sat 9:00-12:00) before the deadline.

For office use only
Checked by: Date:

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Hong Kong Baptist University

Language Centre

Questionnaire on English Learning 2015-2016

Language Centre would be grateful if you could complete the following questionnaire for statistical purposes. The information provided will be kept strictly confidential. Thank you.

A. Your English Language Learning and Achievements Prior to University

1.  Do you regularly speak English at home?

q Yes.

q No. Other regularly spoken language(s):______

2.  Did you travel to an English-speaking country for an extended period prior to university?

q Yes. Please specify:

(i) Country/Region: ______

(ii)  Duration of the trip: ______

(iii)  Purpose of the trip:

q Travelling

q Studying

q Others

q  No.

3.  Name of your Secondary School/ High School: ______

4.  Please indicate which language(s) was/were used as a medium of instruction at your Secondary School/ High School:

q Chinese

q English

q Mixed (Chinese and English)

q Others: ______

5.  The grade breakdown of your HKALE Use of English (AS) results (if applicable):

(i)  Overall Grade: ______

(ii)  Paper 1 – Listening: ______

(iii)  Paper 2 – Writing: ______

(iv)  Paper 3 – Reading and Language Systems: ______

(v)  Paper 4 – Oral English: ______

(vi)  Paper 5 – Practical Skills for Work and Study: ______

6.  The grade breakdown of your HKCEE English Language results (if applicable):

(i)  Overall Grade: ______Syllabus (A/B): ______

(ii)  Paper 1A – Reading: ______

(iii)  Paper 1B – Writing: ______

(iv)  Paper 2 – Listening and Integrated Skills: ______

(v)  Paper 3 – Speaking: ______

7.  Your English grade of other public examination (if applicable):

(i)  Name of the examination: ______

(ii)  English grade: ______

B. Your English Language Learning and Achievements at HKBU

8.  Your performance in Core Requirement English Language courses (if applicable):

(i)  Grade in English I (LANG1491): _____

(ii)  Grade in English II (LANG1492): _____

9.  Did you take any English Elective Courses offered by Language Centre?

q Yes. Please state:

(i)  Course Title: ______

Semester: ______Academic Year: ______

Grade: _____

(ii)  Course Title: ______

Semester: ______Academic Year: ______

Grade: _____

q No.

10.  Did you take any supplementary English courses and/or workshops (non-credit bearing) offered by Language Centre?

q Yes. Please list the course title(s) below:

______

______

______

q No.

11.  Did you use the following services of Language Centre?

(i)  English Writing Enhancement Service: q Yes. q No.

(ii)  English Speaking Enhancement Service: q Yes. q No.

(iii)  Language Learning Oasis (OEM707, Oen Hall, Ho Sin Hang Campus):

q Yes.

a.  How frequently? qRegularly q Occasionally q Seldom

b.  What type of self study materials did you find most useful?

______

q No.

(iv)  Language Inquiry Forum: q Yes. q No.

12.  Did you enter any Public English Speaking or Creative English Writing events at HKBU?

q Yes. Please list the name of the event(s):

______

______

q No.

13.  Did you attend any other English language events held by Language Centre?

q Yes. Please list the name of the event(s):

______

______

q No.

14.  Did you study overseas during your studies at HKBU?

q Yes. Please specify:

(i)  Name of the institution: ______

(ii)  Country/Region: ______

(iii)  Program/Course title: ______

(iv)  Duration of the program/course: ______

q No.

15.  What factor(s) do you think played an important role in your excellent IELTS performance?

______

______

______

Thank you for completing the form.

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