Grantham Scholarships Fund
“Grantham Scholars of the Year” Award 2016-2017
NOMINEE’S PERSONAL PARTICULARS FORM
POINTS TO NOTENominations should be sent together with the following documents:
(i)Principal’sNominationForm;
(ii)A copy of your public examination resultscertified true by the nominating school; and
(iii)Acknowledgement of nomination.
Students arerecommended tomakea copy of this form for reference before submission. Amendments with regard to the information provided in this Form upon submission willnot be accepted. Nominations are deemed to be unsuccessful if the nominating school has not been notified by March 2017.Deadline for submission:16 December 2016
1. / Name in English : / (Please underline the surname) / 2. / Name in Chinese :
3. / Hong Kong Identity Card No. : / (Please put the first four digits) / 4. / Nationality:
5. / Date and place of birth : / 6.Length of residence in HK : / 7. / Age:
8. / Contact Tel No. : / 9. / E-mail address :
10. / Residential Address :
11. / HKDSE/IB/Other public examination results* (please specify: ) (the best6 subjects, including all of the core subjects) :
1.Subject（ ）Grading（ ） / 4.Subject（ ）Grading（ ）
2.Subject（ ）Grading（ ） / 5.Subject（ ）Grading（ ）
3.Subject（ ）Grading（ ） / 6.Subject（ ）Grading（ ）
12. / Please provide details of internal extra-curricular activities from Senior Secondary 1 onwards
(All details MUST BE entered in Appendix I or they will not be considered.)
13. / Please provide details of community services from Senior Secondary 1 onwards
(All details MUST BE entered in Appendix II or they will not be considered.)
14. / Please indicate your current study andthe future career plans upon the completion of the current study
15. / Please indicate the language you prefer to use in the interview
(Students are not allowed to change the chosen language upon submission of this Form)
(Please put a “√” in the appropriate box)
English*(please proceed to item 17) Cantonese**(please proceed to item 16)
* Students are required to use English throughout the whole interview.
** Students choosing Cantonese have to choose a different language for each of the following two parts:
(i) Self-introduction & short speech and (ii) Conclusion
16. / If "Cantonese" has been chosen in item 15, please indicate here the language you prefer to use for Self-introduction & short speech and Conclusion:
(Students are not allowed to change the chosen languages upon submission of this Form)
(Please put a “√” in the appropriate box)
(i)Self-introduction & short speech on a given topic: English Mandarin
(ii)Conclusion : English Mandarin
17. / I have read the Completion Note attached to this form, and I consent to the disclosure of any information contained in this form to other Government policy bureaux and departments for the purpose of processing the nomination. If I am being selected for the award, I also consent to the publication of my name, academic details, extra-curricular activities and community services in any form as the Grantham Scholarships Fund Committee shall think fit.
Nominee’s Signature : / Date :
18. / I certify that the particulars (including those in Appendix I and II) given by the nominee above are correct.
Signature of teacher in charge : / Position :
Name :
Contact Tel No:
Date :
Grantham Scholarships Fund
“Grantham Scholars of the Year” Award 2016-2017
Appendix I
Please list the details of internalextra-curricular activitiesfrom Senior Secondary1 onwards(All relevant details MUST BE entered in this form or the information given would not be considered. Please photocopy this form for use if there is insufficient space.)
Name: School:
* Please “√” in the appropriate box #Please delete where appropriate and/or give details of the equivalent position.
Yes*
(√) / No*
(√) / Duration
(a) / Students’ Council/ Prefects’ Board# / (MM)/(YY) (MM)/ (YY)
Chairperson/ Head Prefect# / / / From ____ / to ____ /
Vice-Chairperson/ Vice/Deputy Head Prefect# / / / From ____ / to ____ /
Prefect/Others#, please specify: / / / From ____ / to ____ /
(b) / Club/Society/Activity Group/ School Team /School Editorial Board/House
(i) / Name of Club/Society/ Activity Group/ School Team /School Editorial Board/House#:
Position
Chairperson/School team Captain/Chief Editor/House Captain or equivalent# / From ____ / to ____ /
Vice-Chairperson/School-team Vice-captain/Head Student Librarian/School Team Leader or equivalent# / From ____ / to ____ /
Executive Committee Member/School Team member/Student Librarian/Member of the Editorial Board or equivalent# / From ____ / to ____ /
(ii) / Name of Club/Society/ Activity Group/ School Team /School Editorial Board/House#:
Position
Chairperson/School team Captain/Chief Editor/House Captain or equivalent# / From ____ / to ____ /
Vice-Chairperson/School-team Vice-captain/Head Student Librarian/School Team Leader or equivalent# / From ____ / to ____ /
Executive Committee Member/School Team member/
Student Librarian/Member of the Editorial Board or equivalent# / From ____ / to ____ /
(iii) / Name of Club/Society/ Activity Group/ School Team /School Editorial Board/House#:
Position
Chairperson/School team Captain/Chief Editor/House Captain or equivalent# / From ____ / to ____ /
Vice-Chairperson/School-team Vice-captain/Head Student Librarian/School Team Leader or equivalent# / From ____ / to ____ /
Executive Committee Member/School Team member/
Student Librarian/Member of the Editorial Board or equivalent# / From ____ / to ____ /
(iv) / Name of Club/Society/ Activity Group/ School Team /School Editorial Board/House#:
Position
Chairperson/School team Captain/Chief Editor/House Captain or equivalent# / From ____ / to ____ /
Vice-Chairperson/School-team Vice-captain/Head Student Librarian/School Team Leader or equivalent# / From ____ / to ____ /
Executive Committee Member/School Team member/
Student Librarian/Member of the Editorial Board or equivalent# / From ____ / to ____ /
(c) / Uniformed Service Groups
(i) / Boy Scouts/Girl Guides# / (Position: ) / From ____ / to ____ /
(ii) / JPC/CYC# / (Position: ) / From ____ / to ____ /
(iii) / Red Cross/ St. John/Air Cadet# / (Position: ) / From ____ / to ____ /
(iv) / Road Safety Patrol / (Position: ) / From ____ / to ____ /
(v) / Others (Please specify: ) / (Position: ) / From ____ / to ____ /
Page (Total page(s))
Grantham Scholarships Fund
“Grantham Scholars of the Year” Award 2016-2017
Appendix II
Community ServicePlease give details of voluntary services performed for the community from Senior Secondary 1 onwards(All details MUST BE entered in this form or the information given would not be considered. Please photocopy this form for use if there is insufficient space.)
Name: School:
Name of Organization / Nature of service / Date of service (MM/YY)
rendered / Number of service hours
rendered*
(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
* Please specify the unit if it is not in hours.
Page (Total page(s))
Grantham Scholarships Fund
“Grantham Scholars of the Year” Award 2016-2017
NOMINATION FORM
1. / I, / , Principal of / ,(School’s name)
wish to nominate / of this school to compete for
(Name of applicant)
the “Grantham Scholars of the Year” Award 2016-2017.
2. / My comments on the above-mentioned student are as follows :-
(i) / Academic achievements :
(ii) / Character and overall capabilities :
(iii) / Participation in extra-curricular activities :
(iv) / Community Services :
(v) / Conduct and any other comments :
3. / I have read the Completion Note attached to this form, and I consent to the disclosure of any information contained in this form to other Government policy bureaux and departments for the purpose of processing the nomination.
Signature / :
Name in BLOCK LETTERS / :
Name of School / :
Address of School / :
School Chop
Region :
HK / KOWLOON * / NT/ISLANDS
Telephone No. / :
E-mail Address / : / Date
Fax No. / :
* According to the classification of the Education Bureau, Kowloon region includes schools in Tseung Kwan O District.
Grantham Scholarships Fund
“Grantham Scholars of the Year” Award 2016-2017
ACKNOWLEDGEMENT OF NOMINATION (to be completed by school)
Official use onlyNomination No.GSF-GSY-1617-
Date on which this acknowledgement was issued:
To: (name of principal) (school fax no: )
From: The Secretary, Grantham Scholarships Fund
This serves to acknowledge the receipt of the nomination(s) for the captioned award. Nominations are deemed to be unsuccessful if the school has not been notified by March 2017.
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Language(s) chosen by the nominee(s) (*Please delete where appropriate)
(i) / Language for interview:((ii) and (iii) are notrequired to fill in if English was chosen for the language for interview.) / (a) / (name of student) / English/Cantonese*
(b) / (name of student) / English/Cantonese*
(ii) / Language for Self-introduction & short speech: / (a) / (name of student) / English/Mandarin*
(b) / (name of student) / English/Mandarin*
(iii) / Language for Conclusion: / (a) / (name of student) / English/Mandarin*
(b) / (name of student) / English/Mandarin*
------------For future correspondence
Name of PrincipalSchool address / Name of Principal
School address
Grantham Scholarships Fund
“Grantham Scholars of the Year” Award 2016-2017
Nomination Form and Nominee’s Personal Particulars Form
Completion Note
Purpose of completing the forms
The personal data provided in the forms will be used by the Trust Funds and Temples Joint Secretariat for the following purposes :
(a)activities relating to the granting of “Grantham Scholars of the Year” Awards;
(b)publicity and ceremonies relating to the “Grantham Scholars of the Year”Awards; and
(c)communication between this office and yourself.
The provision of the personal data is entirely voluntary. However, if you do not provide sufficient information, we may not be able to process your nomination for an award under the “Grantham Scholars of the Year” Award Scheme.
Classes of Transferees
2.The personal data you provide in the form may be disclosed to subject officers of other Government bureaux and departments for the purposes mentioned in paragraph 1 above. Please state the sensitive personal data in the form that you do not like to be disclosed to the above institutions.
3.The names, academic details, extra-curricular activities and community services of the awardees may be published for the purposes mentioned in paragraph 1(b) above.
Access to Personal Data
4.You have a right of access and make corrections with respect to personal data as provided for in sections 18 and 22 and Principle 6 of Schedule 1 of the Personal Data (Privacy) Ordinance. Your right of access includes the right to obtain a copy of your personal data provided by this form.
Retention of Personal Data
5.The application form will be generally retained for 7 years for the audit purpose and the form will be destroyed thereafter.
Enquiries
6.Enquiries concerning the personal data collected by means of this form, including the making of access and corrections, should be addressed to :
Assistant Manager (Trust Funds)
34/F, Wu Chung House
213 Queen’s Road East, Wanchai
Hong Kong.
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