2018 U.S.-Mexico Border Study Program

Name (English) e.g. Chan Dai Man *
Name (Chinese) e.g. 陳大文 *
Nickname e.g. John/Jane *
Gender *

Gender Male Female
Date of Birth Date of Birth * / DD / MM YYYY
Phone e.g. (852) 1234-5678 (Please Use This Exact Format) *
Must be 15 characters. Currently Entered: 0 characters.
University Email *
Personal Email *
Country of Passport Issued *

Country of Passport Issued PRC Hong Kong SAR Macao SAR Other Other
Passport No. *
Passport Expiry Date Passport Expiry Date * / DD / MM YYYY
Need US Visa *

Need US Visa Yes No
University *

University HKU HKUST CUHK HKBU CityU PolyU OUHK HSMC UMac LU Other Other
Student ID *
Year of Study *

Year of Study Postgraduate 4th Year Undergraduate 3rd Year Undergraduate 2nd Year Undergraduate 1st Year Undergraduate
School/Faculty/Department e.g. BA *
Major e.g. Accounting *
Who is Your Emergency Contact *

Who is Your Emergency Contact Father Mother Brother Sister Other Other
Emergency Contact Person Name (English) e.g. Chan Dai Man *
Emergency Contact Person Name (Chinese) e.g. 陳大文 *
Emergency Contact Person Phone No. e.g. (852) 1234-5678 (Please Use This Exact Format) *
Must be 15 characters. Currently Entered: 0 characters.
Emergency Contact Person Email *
Disclaimer The personal data collected will be used by The Hong Kong-America Center (HKAC) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.