Catholic Diocese of Hong Kong
Laity Formation Fund
Application Form
( To be completed by the applicant, to be
typewritten or written legibly in black ink)
Use extra sheets if necessary.
(1) NAME in full: Mr./Mrs./Ms.______(______)
Surname Given name (In Chinese)
(As on Identity Card and inBLOCK LETTERS)
Sex ______Place of Birth______Date of Birth______
Nationality______H.K. Identity Card No.______
Place of Baptism______Active Parish______
Occupation______Organization______
Home Address______
Telephone______Fax No.______(Daytime ) (Mobile / Pager )
E-mail______Marital Status：Married /Unmarried
Name of Spouse______No. of children ______
(2)Proposed studies / course / training ______
Duration of Course / Programme:______Language:______
Diploma /Certificate to be awarded: ______
Name of Institution : ______
Full Address: ______
Annual Course Fee: ______
Sundry Expenses :1.$______2.$______3.$______4.$______
(if any) (Please itemize each type of expenses)
Request for total amount of grant: ______
P. 1
(3) Education and Training in Hong Kong (In Chronological Order)
Year Name of Institution Degree/Certificate/Prize
Awards
______
______
______
______
______
(4) Working Experience
Year Name of Organization Position
______
______
______
______
______
(5) Details of Community/Church Activities you have participated in
______
______
______
______
______
(6)Have you previously studied outside Hong Kong? Yes / No. If “Yes” please give details.
______
______
______
______
P. 2
(7) Are you concurrently applying for any other scholarships? Yes / No. If “Yes”, please give details.
______
______
(8) Language proficiency
Native Language______
* ( Insert any other languages in which you claim to be proficient )
Knowledge of *______Knowledge of *______
Reading：good ( ) average ( ) poor ( )Writing：good ( ) average ( ) poor ( )
Speaking：good ( ) average ( ) poor ( ) / Reading：good ( ) average ( ) poor ( )
Writing：good ( ) average ( ) poor ( )
Speaking：good ( ) average ( ) poor ( )
(9) Details of two referees who have agreed to submit a testimonial regarding you to the Catholic Diocese of Hong Kong Laity Formation Fund.
( Attention please: Referees should know the applicant for at least three years and one of the referees should be a clergy or a religious )
Name( 1 )______( 2 ) ______
Occupation______
Address______
______
______
Telephone______
P. 3
(10) DELCARATION：
I declare that the statements made in the application are, to the best of my knowledge and belief, true, complete and correct. I fully understand the nature, scope, length and the responsibility involved in taking up the course work and / or training I intend to pursue. If awarded a scholarship, I shall do my best to fulfil all requirements as prescribed by the institution. I also accept the full implications of the conditions of the award.
I understand and accept that the information given above will be provided to related units authorized to process the information for purposes relating to scrutiny and granting the scholarship.
Signed：______
Date: ______
(NAME IN BLOCK LETTERS)
P. 4
ANNEX I
CATHOLIC DIOCESE OF HONG KONG LAITY FORMATION FUND
( To be attached to the Application Form )
To be completed by applicant
NAME： ______(______)
Surname Given Name In Chinese
(BLOCK LETTERS )
Degree / Qualifications sought and course of study
______
______
A statement of your reasons for applying for the scholarship, your proposed course of study and your plan of involvement in the Church after your study.
TO BE TYPEWRITTEN OR HAND-WRITTEN LEGIBLY
Signed______
Date______
ANNEX II
CATHOLIC DIOCESE OF HONG KONG LAITY FORMATION FUND CONFIDENTIAL STATEMENT BY REFEREE
(Attention please：Referees should know the applicant for at least 3 years and
one of the referees should be a clergy or a religious)
To be sent under CONFIDENTIAL COVER direct to :-
Catholic Diocese of Hong Kong Laity Formation Fund
12/F., Catholic Diocese Centre,16 Caine Road,Hong Kong.
How long have you know the applicant？______
In what capacity have you known the applicant？______
Please give your opinion about the applicant (Character / Personality / Maturity) :-
______
______
______
How would you rate his/her suitability for the above scholarship？
CIRCLE ONE： ( 1 ) Very Suitable ( 2 ) Suitable ( 3 ) Not Suitable
Kindly give reasons for your rating：______
______
______
Signed：______
Name：______Date：______
( BLOCK LETTERS )
Profession/Occupation：______Telephone： ______
E-mail：______Fax No.：______
Address：______
ANNEX II
CATHOLIC DIOCESE OF HONG KONG LAITY FORMATION FUND CONFIDENTIAL STATEMENT BY REFEREE
(Attention please：Referees should know the applicant for at least 3 years and
one of the referees should be a clergy or a religious )
To be sent under CONFIDENTIAL COVER direct to :-
Catholic Diocese of Hong Kong Laity Formation Fund
12/F., Catholic Diocese Centre,16 Caine Road,Hong Kong.
How long have you know the applicant？______
In what capacity have you known the applicant？______
Please give your opinion about the applicant (Character / Personality / Maturity) :-
______
______
______
How would you rate his/her suitability for the above scholarship？
CIRCLE ONE： ( 1 ) Very Suitable ( 2 ) Suitable ( 3 ) Not Suitable
Kindly give reasons for your rating：______
______
______
Signed：______
Name：______Date：______
( BLOCK LETTERS )
Profession/Occupation：______Telephone： ______
E-mail：______Fax No.：______
Address：______