The data collected will be kept confidential and used by the Hongkong Bank Foundation to process the scholarship application. ATTACHMENT E

HSBC OVERSEAS SCHOLARSHIP SCHEME 2015/2016
UNIVERSITY RECOMMENDATION
APPLICANT’S PERSONAL INFORMATION
Name: / (in Chinese):
Gender: / Birth date: / HK I/D card no.:
Place of birth: / Years of residency in Hong Kong:
Citizenship(s): / Please affix
Father’s occupation: / Mother’s occupation: / recent photo here
Family* income#: HK$ / per month / Number of family* members:
Recipient of government loan (Y/N): / Amount:
Recipient of government grant /
subsidies / allowances (Y/N): / Amount:
Home address:
Contact number (s): / E-mail address: / (school) (permanent)
Overseas residency / studying / travelling experience (Y/N): / If yes, duration/details:
Hobbies:
Name of local university:
Name of degree course: / Duration: / Current year of study:
GPA score / Transcript attached (Y/N):
2014/2015 / 2013/2014 (if applicable)
Name of target overseas university:
Choice of discipline at the overseas university:
Summary of rating:
Excellent / Good / Satisfactory
Intellectual ability
Analytical power
Creativity
Leadership
Communication skills
All-roundedness
Commitment to Hong Kong

*  Family is defined as applicant, applicant’s spouse/parents/siblings/children and any other persons who are financially dependent on the aforementioned members.

#  Applicant may be required to submit supporting documentation to substantiate his/her declaration.

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The data collected will be kept confidential and used by the Hongkong Bank Foundation to process the scholarship application.

ACADEMIC RECORD (continued)
English proficiency test – / Date of test (must be 9 February 2013 or later):
Total Score
(min 90) / Listening
(min 22) / Writing
(min 17) / Reading
(min 21) / Speaking
(min 21)
TOEFL
or
Overall Band
(min 6.5) / Listening
(min 6.0) / Reading
(min 6.0) / Writing
(min 6.0) / Speaking
(min 6.0)
IELTS
Note: To be eligible, your scores must be above the minimum stated above in each category.

TO BE COMPLETED BY THE APPLICANT

IMPORTANT: PLEASE USE THE SPACE PROVIDED BELOW. ADDITIONAL SHEETS/ATTACHMENTS WILL NOT BE REVIEWED.
Extra-curricular activities and community service:
(Please list in chronological order.)
Secondary School:
(Please list in chronological order.)
Work experience (full-time and part-time):
(Please list in chronological order.)

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The data collected will be kept confidential and used by the Hongkong Bank Foundation to process the scholarship application.

TO BE COMPLETED BY THE APPLICANT (CONT’D)
IMPORTANT: PLEASE USE THE SPACE PROVIDED BELOW. ADDITIONAL SHEETS/ATTACHMENTS WILL NOT BE REVIEWED.
Essay: Please use less than 500 words to share with us one area that Hong Kong can do better.
What can be done to address the need and what will you personally do to lead, facilitate or contribute?

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DECLARATION BY THE APPLICANT

I, ______, declare that the information provided above is complete and true to the best of my knowledge. I am aware that the Hongkong Bank Foundation will rely, and consent to the Hongkong Bank Foundation relying, on the information provided by me to determine the eligibility for the scholarship and the amount of the scholarship to be offered to me.

I hereby consent, and confirm that each of the family members and other persons in respect of which personal data or other information (the “Information”) is provided in or in relation to this application consents, to the Hongkong Bank Foundation using the Information for the purposes of considering, processing and administering this application and/or the scholarship granted under this scholarship programme and any purpose directly related to such purposes. I authorise and consent to my university or institution releasing my personal data held by it to the Hongkong Bank Foundation in order for it to use such information to consider, process and administer my application and/or the scholarship granted under this scholarship programme and any purpose directly related to such purposes. I authorise the Hongkong Bank Foundation to (i) transfer the Information and any of my personal data to The Hongkong and Shanghai Banking Corporation Limited (“HSBC”) and for HSBC to use such Information and personal data for the purposes of considering, processing and administering my application and/or the scholarship granted under this scholarship programme and any purpose directly related to such purposes; and (ii) release the results of my application to my university or institution.

Signature of the Applicant:
Name in full:
HKID Number:
Date:


The data collected will be kept confidential and used by the Hongkong Bank Foundation to process the scholarship application.

UNIVERSITY RECOMMENDATION (Please use the space provided)
This part is to be completed by OISE if you are nominated to HSBC

I certify that the above-named applicant has been interviewed by the members of the selection panel and he/she is considered eligible for admission to the Scheme and the overseas university named above.

I understand that the information collected will be kept confidential and used by the Hongkong Bank Foundation to process the scholarship application and for the purposes set out in the Declaration section above. The Hongkong Bank Foundation will not disclose the information collected to any external organisation (other than as stated in the Declaration section above) unless we have the Applicant’s and our consent or are required by law.

Signature: / Date:
(signature with official chop)
Name:
Title:
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RESTRICTED