CUHK Peer Support Network 2025 Application Form 中大朋輩支援網絡申請表

I am applying for (The first preference): 我申請參加 (第一志願)：

I am applying for (The first preference): 我申請參加 (第一志願)： uBuddies Peer Counselling Network 朋輩輔導聯網 uShine SEN Service Team 特殊教育需要服務隊 uPals Wellness Promotion Team 心理健康推廣團隊

I am applying for (The second preference): 我申請參加 (第二志願)：

I am applying for (The second preference): 我申請參加 (第二志願)： uBuddies Peer Counselling Network 朋輩輔導聯網 uShine SEN Service Team 特殊教育需要服務隊 uPals Wellness Promotion Team 心理健康推廣團隊

Gender 性別

Gender 性別 Female 女性 Male 男性

College 書院

College 書院 Chung Chi 崇基 New Asia 新亞 United 聯合 Shaw 逸夫 Morningside 晨興 S.H. Ho 善衡 C.W. Chu 敬文 Wu Yee Sun 伍宜孫 Lee Woo Sing 和聲

Faculty 學院

Faculty 學院 Faculty of Arts 文學院 Faculty of Business Administration 工商管理學院 Faculty of Education 教育學院 Faculty of Engineering 工程學院 Faculty of Law 法律學院 Faculty of Medicine 醫學院 Faculty of Science 理學院 Faculty of Social Science 社會科學院 Other

Year of Study 年級
(Remark: Final year students are not eligible 只接受非畢業班同學申請）

Year of Study 年級 (Remark: Final year students are not eligible 只接受非畢業班同學申請） Year 1 一年級 Year 2 二年級 Year 3 三年級 Year 4 四年級 Other

Status 狀況

Status 狀況 Local Student 本地生 Mainland Student 內地生 International Student 國際生 Exchange Student 交流生

Learning/Training experience in the field of mental health or counselling 曾參加精神健康、輔導等相關課程或訓練

Learning/Training experience in the field of mental health or counselling 曾參加精神健康、輔導等相關課程或訓練 Yes 曾經 No 沒有

Personal Information Collection Statement 收集個人資料聲明（只提供英文版本）
The personal data provided to Wellness and Counselling Centre (WACC) will be used by WACC for the purposes of handling of your enrolment in our programme(s)/workshop(s) and providing services. The provision of personal data is voluntary. However, if you do not provide sufficient information, there may be case that WACC cannot provide the needed service(s) to you. The information given may be held by/ transferred to other parties involved in organising the programme(s)/workshop(s) for the purposes mentioned above. You have the right to request access to and correction of your personal data held by WACC. Enquiries concerning the personal data provided, including data access and data correction requests, should be addressed to Manager, Wellness and Counselling Centre, Office of Student Affairs, 2/F, Pommerenke Student Centre.

Personal Information Collection Statement 收集個人資料聲明（只提供英文版本） The personal data provided to Wellness and Counselling Centre (WACC) will be used by WACC for the purposes of handling of your enrolment in our programme(s)/workshop(s) and providing services. The provision of personal data is voluntary. However, if you do not provide sufficient information, there may be case that WACC cannot provide the needed service(s) to you. The information given may be held by/ transferred to other parties involved in organising the programme(s)/workshop(s) for the purposes mentioned above. You have the right to request access to and correction of your personal data held by WACC. Enquiries concerning the personal data provided, including data access and data correction requests, should be addressed to Manager, Wellness and Counselling Centre, Office of Student Affairs, 2/F, Pommerenke Student Centre. I agree to provide my personal data on this form for the purposes as set out in the “Personal Information Collection Statement” above. 本人同意提供本表格上的個人資料，作為上述「收集個人資料聲明」所列的目的之用。