THE UNIVERSITY OF HONG KONG. Certificate in Chinese Language. Application for Admission

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THE UNIVERSITY OF HONG KONG Certificate in Chinese Language Application for Admission The completed form should be returned to School of Chinese, Room 801, Run Run Shaw Tower, Centennial Campus, The University of Hong Kong, Pokfulam, Hong Kong together with 1. a photocopy of your HKID card/passport/birth certificate; if you are applying on grounds of mature age, an officially certified copy* of the document; 2. the officially certified copies* of academic transcripts and examination results; 3. the proof of payment of the application fee HK$300. (Please refer to the Payment of Application Fee sheet.) An acknowledgement card is issued on receipt of the application. recent passport-sized photograph 1. COURSE OF STUDY SOUGHT # Stream: Putonghua Year: First Cantonese Second 2. PERSONAL INFORMATION Mr./Mrs./Ms./Miss Full name in block letters, surname first Name in Chinese, if any Sex Age Marital status Date of birth (dd/mm/yyyy) HKID Card/Passport number Country of birth Nationality Country of permanent residence Do you require a student visa / student entry permit to study in HK? # Yes No University number (if admitted to HKU previously) Address of correspondence Address in Hong Kong (if any or if different from above) HK telephone number (Mobile) (Office) Email address * Officially certified copies of documents Copies of your original documents [transcripts, examination results, or HKID card/passport/birth certificates (in the case of mature applicants only)] must be certified by the issuing authority concerned or a notary public. The name, status, and position of the person certifying the copies must be clearly stated. In the case of documents supplied by universities and colleges, they should either bear the seals of the institutions and be signed by an appropriate official or be sent to the University directly by the institutions concerned. Alternatively, if you are in Hong Kong, you may bring along the original and photocopies of your supporting documents to the District Offices to make declarations (http://www.had.gov.hk/en/public_services/public_enquiry_services/provided.htm) and submit the declared documents by post or in person. Please DO NOT send your original documents by post. The University is not responsible for any documents lost in the post. Transcripts and diplomas which are not in English should be accompanied by a certified translation in English. # Please tick as appropriate.

3. ACADEMIC QUALIFICATIONS (attendance at education institutions after the age of 12 years) Institution Level reached Period of attendance From To Degree or Diploma Date of award Additional qualifications to be obtained by the coming August 31, if any Expected Date Qualifications 4. PREVIOUS KNOWLEDGE OF CHINESE LANGUAGE Language courses Period of attendance From To Qualifications obtained (if any) 5. SPONSORING AUTHORITY (if applicable) 6. CURRENT EMPLOYMENT (if applicable) 7. REASONS FOR APPLYING THE COURSE 8. INTERESTS/HOBBIES 9. DECLARATION I, (full name), declare that the data given in support of this application are, to the best of my knowledge, accurate and complete. I understand that the data will be used in the admission decision process and that any misrepresentation will disqualify my application for admission and enrolment in the University. authorize The University of Hong Kong to obtain, and the Hong Kong Examinations and Assessment Authority and other relevant authorities to release, any and all data concerning my results of the HKDSE, HKALE and HKCEE, other public examinations, and my studies in institutions in Hong Kong and elsewhere. I also authorize The University of Hong Kong to use my data in this form for the purpose of obtaining such information. authorize The University of Hong Kong to use my data to carry out checks on my academic status, such as multiple admission applications, records of previous studies in educational institutions. Similarly, I authorize the University to use my data for checks in regard to my employment history.

understand and accept that, upon my registration in a programme, the data in this form and those the university is authorized to obtain will become a part of my student record and may be used, processed, and transferred for all legitimate purposes relating to my academic and non-academic activities in accordance with the procedures of the University. understand that if I am a current full-time Bachelor s degree student in one of the local UGC-funded tertiary institutions or a de-registered or discontinued student of the University and I fail to declare this, I may be disqualified even after being offered admission. note the general points pursuant to the Personal Data (Privacy) Ordinance as set out in the Personal Information Collection Statement. Signature: Date: CCL FORM OCTOBER 2016

THE UNIVERSITY OF HONG KONG Payment of Application Fee 1. The application fee is HK$300 (non-refundable). 2. Methods of Payment: Local applicants residing in Hong Kong: (a) Please pay the application fee, using one of the methods overleaf; or (b) Please complete the form below for payment by credit card. If you are using the payment methods in 2(a) above, it is essential that the original ATM customer advice, or in the case of internet banking, a printed copy of the bank s acknowledgement statement which contains the payment reference number be stapled to your application form for submission to the University. Please retain a photocopy of the receipt as proof of payment of the application fee. Oversea applicants should pay by bank draft (in Hong Kong Dollars) drawn on a bank in Hong Kong and made payable to The University of Hong Kong, or by credit card (please complete the form below). CREDIT CARD PAYMENT Full name of applicant (as given on the application form): Please complete and attach this form to your paper application if you choose to pay the application fee by credit card. Credit Card (Please tick) VISA MASTER Name printed on credit card (BLOCK LETTERS) Card Number Expiry Date - - - / (Month/Year) To the Registrar: I hereby authorize The University of Hong Kong to charge HK$300 to the above credit card account to cover the application fee for Certificate in Chinese Language 2017-2018. Signature of credit card holder: Date: (Please use authorized signature as on your credit card.)

Methods of Payment (for Local Applicants only) Payment method ATM (Automatic Teller Machine) Internet banking Procedures 1) Locate an ATM with Bill Payment function 2) Select Bill Payment Education The University of Hong Kong (Please do not use the account transfer function for payment) 3) Enter Bill Type: 06 Other Fees 4) Enter 14-digit Bill Account Number: 20999999834001 5) Enter amount of payment: HK$300 6) Please retain a copy of the ATM transaction advice as your proof of payment. 1) Logon to any of the following websites: HSBC <http://www.hsbc.com.hk> Hang Seng Bank <http://www.hangseng.com> JETCO <http://www.jetco.com.hk> BEA <http://www.hkbea.com> 2) Make bill payment by choosing the following function: (Please do not use the account transfer function for payment) HSBC: View and Pay Bills Hang Seng Bank: View and Pay Bills JETCO: JET Payment BEA: Bill Payment / CyberPayment / JET Payment 3) Select The University of Hong Kong as the merchant for payment 4) Enter Bill Type: 06 Other Fees 5) Enter 14-digit Bill Account Number: 20999999834001 6) Enter amount of payment: HK$300 7) Please print a copy of the bank transaction confirmation as your proof of payment Receipt to be attached to the application form Original ATM customer advice A printed copy of the bank s acknowledgement statement which contains the payment reference number

THE UNIVERSITY OF HONG KONG 香港 大學 Dear Applicant, Date: Application for Admission to Certificate in Chinese Language Your application for admission has been received and is being processed by School of Chinese. Note: If you wish to receive an acknowledgment of your application, please write your name and address and affix stamp below. Please affix stamp Name: Address:

159/716 THE UNIVERSITY OF HONG KONG Personal Information Collection Statement for Applicants and Students 1. This is a personal data collection statement made under the Personal Data (Privacy) Ordinance ( the Ordinance ). 2. Personal data provided by you to The University of Hong Kong ( the University ) through the completion of admission application and, if admitted, through the registration procedures and during studies at the University will be used for the University to perform its administrative, education, academic and research functions, and for the directly related purposes. 3. Unless otherwise specified, provision of personal data is voluntary. However, failure to provide the relevant personal data will render the University unable to perform the relevant functions, e.g. unable to consider your application for admission or provide the facilities or services. 4. Without prejudice to the foregoing, the purposes and use of the personal data collected are elaborated as follows. 5. As regards your application for admission, the personal data collected will be used for the purposes prescribed in the application forms/documents and will serve the following purposes: a. as basis for selection for admission, award of entrance scholarships, and communication on admission-related matters; b. as evidence for verification of your identity, your qualifications and academic records in relevant institutions and organizations in Hong Kong or other places, and other information provided in the application forms/documents; and c. identifying possible multiple applications and records of your previous and existing studies at the University and other institutions. 6. In case of application for admission to a programme jointly offered or collaborated by the University and its partner institution(s), your personal data provided to the University will be transferred to the partner institution(s) concerned for the purposes as stated in paragraph 5 above. 7. If you are admitted as a student of the University, your personal data provided during the application process will be transferred to the student record system of the University, together with your personal data (including the photo image) provided during registration, to become part of your official student records. 8. Personal data of the students of the University will be used for all purposes relating to studies at, activities conducted by, and facilities, services and benefits provided by the University (in particular those governed by the relevant regulations, policies and procedures of the University). Personal data and photo images of students may also be

2 used by the Hong Kong University Students Union for the production of membership cards and conduct of activities. 9. Personal data of the students of the University (including study records) will be used by the University, during studies at and after leaving the University, for conducting statistical analysis, research, survey, review and audit. 10. Upon leaving the University, personal data of the students of the University will also be used for maintaining contact, updating the latest developments of the University, and provision of information (such as activities of the University). 11. Your personal data will be kept confidential and handled by the authorized staff members of the University. The University may transfer your personal data to parties outside the University, for the above functions and purposes, such as processing of student visa, arrangements of activities (including but not limited to exchanges, internships, placements, and field trips), and granting of scholarships and financial aids, and when it is required by law. 12. Under the provisions of the Ordinance, you have the right to request the University to ascertain whether it holds your personal data, to request it to supply to you a copy of the data, and to apply for correction of the data, as necessary. Applications for access to personal data should be made by using the specified form and on payment of a fee. Requests for correction of personal data should be made in writing with supporting documentation. Please address such applications and requests to the Data Protection Officer, Registry, The University of Hong Kong, except for requests for access to examination-related personal data which should be submitted to the office of the home Faculty direct. 13. You may click here for the Privacy Policy Statement of the University. July 2016 H.W.K. Wai Registrar