Ref. No: ______

(For office use only)

S.H. HO COLLEGE

THE CHINESE UNIVERSITY OF HONG KONG

International Internship Programme 2017

Application Form

Notes to Applicants (Please read the following thoroughly before filling out the form.)
1.  The information provided will be used for the purposes related to student affairs of the College. It may be accessible to offices, committees or persons who will handle student activities. The information will be destroyed when no longer required.
2.  Please return the completed application form to the Dean of Students’ Office, S.H. Ho College by 12:00 noon 9 January 2017 (Mon).
3.  Applicants who fail to attend the interview will not be considered.
4.  All participants need to fulfill the following obligations of the internship programme:
a. To submit all completed documents to the College and Pacific BMW including but not limited to a Letter of Undertaking and Health Declaration; and
b. To submit a written evaluation report to the College and Pacific BMW as requested. The College reserves the right to edit the report for publication purposes
5.  For enquiries, please contact Miss Gloria Tsoi at .

Part A: Personal Particulars

Name in English: / Name in Chinese:
Student ID: / Year of Attendance:
HKID: / Passport No.:
Passport Issued by: * / HKSAR/Others (please specify):
American Visa: * / I have applied / not applied before / Passport Expiry Date:
Nationality: / Gender:
Date of Birth: / Student Type: * / Mainland / Local / International
Major: / Minor:
Email: / Contact Tel:
Correspondence Address:

* Please circle as appropriate.

Part B: Special Skills & Interests

Language proficiency / Written English ¨Fluent ¨ Good ¨ Fair ¨ Poor
Spoken English ¨ Fluent ¨ Good ¨ Fair ¨ Poor
Computer skills
Other skills
Interests

Part C: Internship / Work Experience (in chronological order)

Year / Organization / Description / Post
From / To


Part D: Other Extra-Curricular Activities (in chronological order)

Year / Organization / Description / Post
From / To

Part E: Essay

Please write an essay in English in at least 300 words to state the reasons why you are interested in joining this overseas internship programme, your expectation, and the plans of getting yourself prepared for the programme. (Additional paper may be attached to supplement the application.)

Part E: Declaration

I declare that the information provided on this application is complete and accurate. I will comply with all Pacific BMW's requirements. I understand any misrepresentation or omission on the application may lead to disqualification from application. I fully understand that, upon my acceptance for the International Internship Programme of S.H. Ho College, I am abided by the terms of the Programme. Any breach of the obligations may result in disciplinary action(s) deemed necessary and appropriate by the College authority.

Signature of Applicant: Date:

(Name in BLOCK: )

Page 1 of 2