No. ______

THE CHINESE UNIVERSITY OF HONG KONG

Hamen and Phyllis Fan Scholarship for Overseas Studies 2018/19

Resume of Applicant

1.The information gathered will be used for Scholarships/Awards-related purposes in the University. It may be accessible to offices, committees or persons involved in Scholarships/Awards matters. Records of unsuccessful candidates will be destroyed when no longer required.

2.The application form should be typed in English and signed. Handwritten form will NOT be accepted. If the item(s) in the form is/are not applicable, “N/A” should be marked.

3.Please DO NOT use digital camera or smart phone to take snapshot of the supporting documents. Otherwise, these supporting documents may be considered invalid.

(A) Personal Data
Name / CU Student ID No.
(In BLOCK LETTERS,
SURNAME FIRST) / (In Chinese)
Gender / Major / Programme of Study @
Mode of / Current Year / Expected
Study / Full-time / College / of Study / Yr. / Graduation inν / / 20 / (MM/YYYY)
Place of
Residency / Local / Non-local * / Birth / Citizenship
Home Address
Telephone / Mobile

E-mail Address

/

(CUHK)

/

(Personal)

@Please type the full programme title, e.g. BEng. in Electronic Engineering, BSc in Computer Science
νPlease put down the expected graduation term and year in CUSIS
*Please delete whichever is inappropriate

(B) Academic Results at this University

Cumulative GPA (first year of study) : / (in 3 decimal places)
Cumulative GPA (second year of study) : / (in 3 decimal places)
Cumulative GPA (third year of study) : / (in 3 decimal places)
Cumulative GPA of ELITE Courses completed (including engineering courses at 5000 level orabove) : / (in 3 decimal places)
Please list all the ESTR Courses and engineering courses at 5000 level or above that you have completed:
Academic Year and Term / Course Code / Course Title / Course Grade
(C) Award History (Please put a ‘’ in an appropriate box.)
Have you ever received any scholarships during your studies in CUHK?
/ Yes / / No
If Yes, please specify the name and amount of the scholarship(s):
Name of Scholarship(s): / Award Year / Awarded Amount (please specify if it is not in HK$)
1.
2.
3.
4.
5.
(D)Awards / Achievements received in the recent 3 years (i.e. from 1 January 2015 and thereafter)
It is mandatory to provide proofs on ALL awards / achievements stated below (e.g. certificate, award letter / email, etc.).
Month / Year /

Official Name of Award / Competition / Event[1]

/

Organizer

/

Website of Award /

Competition /

Event[2]

/

Scale[3]

/

Result and/or Amount[4]

(MM/YYYY)
1.
2.
3.
4.
5.
[1]Please use the OFFICIAL name of the award / competition / event and DO NOT make any translation even if the name is only in Chinese. The competition should have already been held.
[2]Apart from the website, please provide information on the award / competition /event (e.g. poster, leaflet, email, etc.) in hardcopy.
[3]Please state the Scale – International; Regional; National; Local / Inter-School / Inter-University.
[4]Please provide the amount of the award and specify its currency (e.g. HKD, USD, RMB, etc.) if applicable. If it is not specified, the currency is assumed to be HKD.
(E)Extra-curricular Activities you have chosen above in the recent 3 years (i.e. from 1 January 2015 and thereafter)

From

/

To

/

Student Organization / Activities

/

Post / Contribution

(MM/YYYY) / (MM/YYYY)
1.
2.
3.
4.
(F) Declaration 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 Faculty of Engineering (FoE) of The Chinese University of Hong Kong to obtain any information from other units of the University which FoE considers necessary and relevant to the administration and assessment of my application for the captioned Scholarship.
I give my consent that:
-the information provided will be used by the University to process the application and for other related purposes; and
-FoE can announce my name and major in print or online should I be offered the Hamen and Phyllis Fan Scholarships for Overseas Studies.
I also undertake to inform the Faculty of Engineering as soon as practicable of any awards/scholarships/prizes conferred to me after submission of this form.
Signature of Applicant: / Date:

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