Office of Service-Learning, Lingnan University

Mainland and International Service-Learning Program 2016– 2017 Application Form

Office of Service-Learning, Lingnan University

Mainland and International Service-Learning Program (MISLP)

Application Form

Please read the Notes before completing your application

Application Deadline: 24OCT 2016(MON), By17:00nn (GMT+8)

IMPORTANT NOTES


  1. PERSONAL INFORMATION

English Name: / Chinese Name: / Preferred Name:
Gender: / Date of Birth:
(DD/MM/YY) / Place of Birth:
Student ID.: / Major/Stream: / Year of Study:
Program Nature: / □ Undergraduate / □ Exchange / □ Post-graduate / Cumulative GPA:
Phone no.: / (Mobile) / (Home)
Email:
Are you the 1stgeneration of full-time undergraduate student in your family? / □Yes □No
  1. PROGRAMS OF INTEREST

Please prioritize the Service-Learning project(s) that you want to apply (1 being your first priority).
For more information about each individual project, please refer to the OSL website:
Program
Type / Location / Project Name / Priority
Credit Bearing / Hong Kong, Yunnan / Cross-Border Service-Learning Summer Institute (CLE9027 /SLSI)
Indonesia / Indonesia Community Outreach Program (COP)
Project-Based / Yunnan, China / A Village Adoption Project in Yunnan
Changsha, China / Changsha Service-Learning Project
Guangdong, China / Guangdong JIA Work Camp (JIA)
Kolkata, India / India Service-Learning Project
Taiwan / Taiwan Service-Learning Project
Research-Based / Beijing, China / Beijing Service-Learning and Research Project
India / India Service-Learning and Research Project
Sponsorship-Based / Madurai, India / Lady Doak College International Service-Learning Program
Seoul, Korea / Seoul Women’s Unversity Global Service-Learning Program
Taiwan / Taipei Medical University Service-Learning Program
China / Tsinghua University Summer Service-Learning Program (SSLP)
  1. TRAVEL EXPERIENCE
    If any, please state and specify the countries or cities which you have visited.

Year of Visit / Country/
City Visited / Purpose of Visit / Length of Visit
  1. SERVICE-LEARNING EXPERIENCE
    Please list out the local, mainland and international Service-Learning projects and/or other Service-Learning related opportunities (E.g. Teaching assistant, S-L Student Association, Project Coordinator) offered by the Office of Service-Learning which you have joined.

Academic Year /
Semester / Service-Learning Project Name / Course Code / Course Name
Example:
2015-2016 (Semester 1) / English Class for Ethnic Minority Children / SLP1101 / Community Engagement through Service-Learning
  1. EXTRA-CURRICULAR ACTIVITIES

Please state and specify your extra-curricular activities(including school society, part-time job, student exchange program, school team, etc.) in the past three years in chronological order. (If any)

Program /Activity / Organization /Agency / Position Held / Responsibilities / Date (Month/Year)
From / To
  1. COMMUNITY SERVICE
    Please state and specify the community service you have participated in in the past five years in chronological order. (If any)

Organization / Agency / Position Held / Responsibilities / Date (Month/Year)
From / To
  1. LANGUAGE PROFICIENCY

Reading / Writing / Speaking / Listening
  1. Cantonese

  1. English

  1. Mandarin

  1. Other:

Please indicate your language proficiency level.
The levels are: Native (N), Excellent (E), Good (G), Basic (B), Not Applicable (N/A)

  1. PLAN FOR SUMMER PERIOD

Please “” and specify ALL of your engagement during summer period.

  1. Will you be out of Hong Kong during summer period(18 May to 31 Aug 2017)?

□ Yes / ( / Time Period: / )
□ No
  1. Do you have any of the following engagement during summer period(18 May to 31 Aug 2017)?

□ Faculty / Society based StudentOrientation Camp / ( / Time Period: / )
□ New Student Orientation Camp (NSO) / ( / Time Period: / )
□ Part-time Job / ( / Organization: / )
( / Position Held: / ; / Time Period: / )
□ Others / ( / Please Specify: / )
□ No
  1. Will you take part in any international / exchange program (s) organized by other department / organization in semester 2 of academic year 2016-2017 and/orsummer period(18May to 31 Aug 2016)and/or semester 1 of academic year 2017-2018?

□ Yes / (Program(s) / and time period: / )
□ No
  1. ESSAY QUESTIONS

1. State at least two things that you expect to learn through this experience. (150 words)

2.What does Global Citizenship mean to you? (150 words)

3. Please state and explain your perception toward a social issue in the chosen service country which concerns you most. (300 words)

4.List out your top 3 strengths and weaknesses.

Strengths / Weaknesses
  1. OTHER INFORMATION

Please write in the space provided if you have other information that you would like to give for your application.

  1. DECLARATION

I declare that I have read the Important Notes for this application. I also declare that, to the best of my knowledge, all the information included and attached to this application is accurate.

Signature / Date

Confidential Recommendation Form機密推薦表格

To the Applicant致申請者：

Submit this form to someone who is familiar with you, ideally a mentor, a teacher, an employer, or a co-worker. The referee should not be your friend or a family member. The recommendation form will be regarded as invalid if it does not have your referee’s signature or is incomplete.

請將此推薦表格交予一位熟悉你的推薦人。推薦人可以是你的導師、老師、僱主或同事等，唯家屬或朋友不能成為你的推薦人。若閣下未能提供:1) 推薦人簽署或2) 完整資訊，此推薦表格將不獲接納。

Name of applicant 申請人姓名

To the Referee 致推薦人：

The Office of Service-Learning at Lingnan University organizes the Mainland and International Service-Learning Program (MISLP) to give students opportunities to explore service-learning and different global issues outside Hong Kong. For more information about MISLP, please visit our website ( or Facebook (search for “Mainland and International Service-Learning Program”）

The above applicant has requested your recommendation to supplement his/her application for MISLP 2016-2017. Please provide information about his/her character, academic abilities and community service interests; he/she can inform you more about the selection criteria and the particular programs he/she is applying to. Your comments and information are very helpful for our selection of applicants. The information you provide will be used for MISLP participant selection only.When you finished your recommendation, please return the sealed letter and signed form to the applicant by his/her requested date.You can write your recommendation letter in either English or Chinese.

嶺南大學服務研習處籌辦多項內地及國際服務研習計劃，讓學生獲得香港以外的服務研習體驗及探討其他全球性議題。如欲索取更多有關內地及國際服務研習計劃的資訊，可瀏覽計劃網頁( and International Service-Learning Program”）。

請提供有關申請人的品格、學術能力及對社會服務的興趣等資料及評語。你提供的資料及評語將大大幫助我們甄選合適的參加者。如有需要，請另加頁數。推薦內容只用於是次內地及國際服務研習計劃甄選過程之用。請將推薦評語及填妥的推薦表格封妥，於截止限期前直接交回申請人。推薦信可以使用中文或英文書寫。

Name of referee
推薦人姓名 / Title of referee
推薦人稱號或職銜
Company/ Organization
公司/機構 / Contact number/ e-mail
推薦人聯絡電話或電郵
Relationship to applicant
與申請人的關係 / The length of time that you have known the applicant
與申請人認識時間
Comments on the applicant對申請人的評語(Separate sheets if necessary如有需要，可另加紙張補充)
Signature of Referee
推薦人簽署 / Date
日期

Thank you very much for your kind help! 多謝你的協助!

Page 1 of 7