Centaline Charity Fund Scholarship

Application Form 2013/2014

For internal use only

Application No.

A. Personal Information
Chinese Name

English Name () (Fill in block

Photo

letters)

HKID card no. 1

Date of Birth (YYYY/MM/DD)

Place of Birth

Gender

Residential Address () (Fill in block letters)

Type of accommodation
Private Property

Housing Ownership Scheme

Public Housing

(HOS)
Housing ownership
Self-owned

Rented

Others, please specify:

Accommodation expenses
Mortgage payment

Rent

Monthly(HKD)

Not Applicable

Monthly(HKD)

___________________________

_________________________

Home Phone

Mobile Phone

Email Address
Personal Account Info (Applicant must be the only owner of the account. Deposit account, credit card account
or foreign currency account will not be accepted.)
Name of Bank ______________________________________________
Account Name ______________________________________________
Account Number ______________________________________________
Reasons for applying for the application (Please check all that are applicable)

Support tuition

Support cost of

Support medical

Support living

Others, please

costs

materials

expenses

expenses

specify:

 Proposed future occupation in Hong Kong

B. ()

Family members (Guardian, Parents and Siblings)

Name

Relationship

Age

Occupation/

Type of position

Monthly Salary

Contact

Grade

FT/ PT

Yes/

No.

to applicant

No
1.
2.
3.
4.
5.
6.
7.
8.

C. Family Status
Family subvention situation
CSSA

Disability Allowance

() Old Age Allowance

() Monthly(HKD) _________

() Monthly(HKD) _________

() Monthly(HKD) __________

/ Retirement

Contributions from relatives

benefits/Pensions

and friends

Allowance

() Monthly(HKD) _________

() Monthly(HKD) _________

() Monthly(HKD) __________

Old Age Living

Others, please specify:_______________________________________________________________

() Monthly(HKD) __________________________________________________________________________
Parents marital status
Divorced

Separated

Never Married

Widowed

/ Members whom you live together who are disabled or chronic patients
1.

2.

Name

Relationship

Health Status

Name

Relationship

Health Status

: Other special circumstances and large expenses, please specify:

Any family members who have applied for the Centaline Charity Fund Scholarship?
Yes

Name

Year of

Relationship

Application

Successful

Unsuccessful

No

D.

University Offers 1

Name of

College

Department/

Course of study

Expected Starting

()

Year/Month

Total School Fee for

University

Faculty

this academic Year

(HKD)
1.
2.
3.

E. ()
application)

Other Scholarship Applications (Except this scholarship

Name of Scholarship

Organization

()

Amount (HKD) Notification Date

Application Status
//
Successful/
unsuccessful/
unknown

1.
2.
3.

F. Education

School Type

Name of School

School Address

Govt/ Aided/

Period of

Grade

Private/ DSS/

Study

CAPUT
1.
2.
3.
4.
5.

G.

Pubic examination results in the most recent two academic 1

H.

Academic transcripts in the most recent two academic years 1

I. 700
You are required to submit a typewritten personal statement of your future goals or career
plans and how will your field of study assist you to achieve your goal and serve the
community in Hong Kong in no more than 700 words.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

J.

1
Academic and non-academic awards in the most recent two academic years

Organization

Date of
Commencement

Name of Award

1.
2.
3.
4.
5.
6.
7.
8.

K.

Extra-curricular activities or voluntary services in the most recent two years

Activity

Organization

Nature of Activity

Year/Month

Position held2

1.
2.
3.
4.
5.
6.
7.
8.

L. Personal Interest
1. ______________________________________________________________________________________________
2. ______________________________________________________________________________________________
3. ______________________________________________________________________________________________
4. ______________________________________________________________________________________________
5. ______________________________________________________________________________________________

M.

Referee 3

Name

Relationship

Name of School

Contact Number

1.
2.
3.

N. Others
()
Sources from which you obtained information about the Centaline Charity Fund Scholarship (check all that apply)

Homepage of Centaline Charity

E-mail/e-notice from university

Relatives and friends

Fund

Homepage of Centaline Property

E-mail/e-notice from secondary

Agency

school

Others, please specify:

O. Declaration
1. 4

2.

3.

1. I am/ am not 4 a Hong Kong permanent resident; or

Prior to application, I have resided in Hong Kong continuously for 3 years and my parents or
one of them is a Hong Kong permanent resident.
2. I agree to return the full amount of Centaline Scholarship to Centaline Charity Fund
Limited before the end of that academic year if I am unable to complete/ have to
end the academic programme I am pursuing during that academic year regardless
of the reasons.
3. I thereby declare that the statements made in this application are, to the best of my
belief, true, complete and correct. I agree that Centaline Charity Fund Limited can
contact the above listed organizations or individuals for inquiries regarding my
Scholarship application.
Signature of Applicant

______________________________
Date (YYYY/MM/DD)

PS
1
2
3

Please provide softcopies of supporting documents.

Please specify the position as member, group leader or executive committee.
Please provide all reference letters by the referees, referees must be school principal, Department Head or Class
Teacher.

Please delete the unnecessary choice.

Please attach extra pages if needed.

20138161159 ()

1.
2.

PDF10MB
ccfscholarship@centamail.com

3.

a.
b.
c.
d.
e.
f.

PDF

4.
5.

6.

7.

()

8.

210
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Attention
1. The deadline of submission is 16th August, 2013 11:59pm (as indicated by the Centres
server)
2. After completion of application form, please scan in full colour, all pages of the application
with the attached personal statement and softcopies of supporting documents, then save
all documents as one PDF file and compress the file to 10MB and submit it via email to
ccfscholarship@centamail.com.
3. The following applications will not be considered, the Centre will not notify the applicants in
person:
a. Any electronic document that is not in a PDF format
b. Any application that is not submitted via email
c. Any unclear application
d. Applications with any missing pages or incomplete sessions
e. Applicants who fail to provide other required supporting documents without sufficient reasons
f.

Any further documentations or information must be submitted by the deadline indicated by the
Centre
4. All supporting documents or softcopies of reports must be submitted at the end of the
application form according to the sessions in the application form.
5. Shortlisted applicants will be invited to an interview via email within a month after the
deadline of the application. Those who did not receive email notification within a month can
consider their applications unsuccessful.
6. Submitted applications and relevant documents will not be returned once they have been
processed.
7. Any submitted information is protected by the Personal Data (Privacy) Ordinance. The
information will only be used for this application and related statistics.
8. If there is any misreport of information in the applications, the applications may not be
considered/ the awardee will be asked to return the full amount of Scholarship. Please be
noted that any person who by any deception dishonestly obtains for himself or another any
pecuniary advantage shall be guilty of an offence and shall be liable on conviction upon
indictment to imprisonment for 10 years under the Theft Ordinance (Chapter 210 of the
Laws of Hong Kong).

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1.

2.

3.

4.

5.

6.

Checklist for required documentation softcopies

1. Applicants Identity Card
2. Applicants University admission letter
3. Applicants Public Examination Records (the most recent 2 years)
4. Applicants Secondary School Academic Reports (the most recent 2 years)
5. Applicants proofs of any academic and non-academic awards received in the most recent 2 years
6. Reference Letters

Enquiries

Address

Centaline Charity Fund Limited

18 22
22/F, New World Tower 1, 18 Queens Road Central, Hong Kong

Hours

9 30 1 Mon-Fri 9:30am-6pm

Contact person

Ms. Tang

Phone

(852) 2501 1505 / (852) 2521 8402

Email for enquiries

ccf@centamail.com

Email for Application Submission ccfscholarship@centamail.com

Website

www.centacharity.com.hk

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