Summer Overseas Language Programme 2016-17 - The Univeristy of Western Australia

性別 Sex

性別 Sex M F

年級 Year

年級 Year 一年級 Year 1 二年級 Year 2 三年級 Year 3 四年級 Year 4 五年級 Year 5

Have you received any scholarships/sponsorships from the College to participate in non-local activities before?

Have you received any scholarships/sponsorships from the College to participate in non-local activities before? Yes No

本人謹聲明在本申請表所填各項資料及提交之証明文件均確實無訛，並授權書院相關職員在有需要時向大學教務處及本人所屬學系查詢本人之學業成績紀錄。
I hereby declare that all information and supporting documents provided herein are true and complete. I also agree to authorize the related officers of the College to obtain information regarding my matriculation results from the Registry of the University or relevant Faculty for verification purpose when necessary.

本人謹聲明在本申請表所填各項資料及提交之証明文件均確實無訛，並授權書院相關職員在有需要時向大學教務處及本人所屬學系查詢本人之學業成績紀錄。 I hereby declare that all information and supporting documents provided herein are true and complete. I also agree to authorize the related officers of the College to obtain information regarding my matriculation results from the Registry of the University or relevant Faculty for verification purpose when necessary. I declare & agree

收集個人資料聲明 Personal Information Collection Statement

1. 此表格所收集的資料將用作申請暑期海外語文團之用。所收集得的個人資料將會絕對保密，並於無需保留時全部銷毀。The information provided in this application form will be used for the application of Summer Overseas Language Programme. The information collected will be kept confidential and will be destroyed when no longer required.
2. 如申請人未能提供足夠的個人資料，本院可能無法處理有關之申請。 The College may not be able to process applications with insufficient personal data.
3. 此表格所收集的資料或會轉交香港中文大學其他部門作考慮或批核用。The information provided in this application form may be transferred to other departments / units within CUHK for consideration and granting approval, where applicable.
4. 申請人如欲更改所提供的個人資料，請以電郵聯絡伍宜孫書院辦公室李潔瑩女士 (michelleli@cuhk.edu.hk)。For correction of the personal data provided, please contact Ms Michelle Li of the College Office of Wu Yee Sun College by email (michelleli@cuhk.edu.hk).

收集個人資料聲明 Personal Information Collection Statement 1. 此表格所收集的資料將用作申請暑期海外語文團之用。所收集得的個人資料將會絕對保密，並於無需保留時全部銷毀。The information provided in this application form will be used for the application of Summer Overseas Language Programme. The information collected will be kept confidential and will be destroyed when no longer required. 2. 如申請人未能提供足夠的個人資料，本院可能無法處理有關之申請。 The College may not be able to process applications with insufficient personal data. 3. 此表格所收集的資料或會轉交香港中文大學其他部門作考慮或批核用。The information provided in this application form may be transferred to other departments / units within CUHK for consideration and granting approval, where applicable. 4. 申請人如欲更改所提供的個人資料，請以電郵聯絡伍宜孫書院辦公室李潔瑩女士 (michelleli@cuhk.edu.hk)。For correction of the personal data provided, please contact Ms Michelle Li of the College Office of Wu Yee Sun College by email (michelleli@cuhk.edu.hk). I read & understood

Summer Overseas Language Programme 2016-17 - The Univeristy of Western Australia

個人資料 Personal Particulars

曾參與之書院活動及語文活動 College Activities and Language Activities Participated

申請計劃之原因 Why you are interested in the programme

聲明 Declaration