Form 1 CSP10 Application Form.doc

Form 1: CSP10 Application Form (For Mainland China Students Only) Applicant No. (For office use only) C S P 1 0 (1) Name: (English) (Chinese) (Family) (First) (2) Gender: (M/F) (3) Date of Birth: (dd) / (mm) / (yyyy) (5) Place of Birth: (*) (Country) / (Region) (6) Travel Documents: (*) (a) For traveling in Mainland China ( PRC Resident Identity Card 中華人民共和國居民身份證 Document No.: Expiry Date: _____/_____/______(dd/mm/yyyy) (b) For entering Hong Kong (Please select by placing a tick “(”) ( Permit for Travelling to and from Hong Kong and Macau 往來港澳通行證 Document No.: Issuing Authority: Issuing Date: _____/_____/______(dd/mm/yyyy) Expiry Date: _____/_____/______(dd/mm/yyyy) OR ( Other 其它證件 (Please specify请寫明：______________) Document No.: Issuing Authority: Issuing Date: _____/_____/______(dd/mm/yyyy) Expiry Date: _____/_____/______(dd/mm/yyyy) B. (1) Correspondence Address: (*) B. (2) Email Address: (*) B. (3) Tel. No.: (*) 86 B.(4) Mobile No.: 86 Country Code Area Code Phone No. Country Code Phone No. B. (5) Residential Address: (*)(if different from correspondence address) B. (6) Emergency Contact B. (6 a) Name of Person: (*) B. (6 b) Relationship: (*) B. (6 c) Address: (*) B. (6 d) Tel. No.: (*) 86 B. (6 e) Mobile No.: 86 Country Code Area Code Phone No. Country Code Phone No. (1) Particulars of Current Academic Programme (1 a) Country/Region of Institution currently attending : Mainland China (b) Name of Institution currently attending (所在學校): (中文) (in English) (c) Faculty/Department(系): (中文) (in English) (d) Programme/Course(專業): (中文) (in English) (e)Year of Study(年級): (f) Expected Date of Graduation (預計畢業日期): (3) Academic Attainments, Distinctions or Scholarships / Awards previously attained or currently receiving List three of the most significant scholarships / awards you received in the present and previous 3 years. (列出你在过去3年内曾经获得的3项最杰出的学术成就，例如奖学金或学术奖项) N