Registration Form: CT-P-15019 A Journey throught Stories CT-P-15019 A Journey through Stories(1) Personal Information 個人資料Name of the Student (in English) 學生英文姓名 *Surname 姓氏 *Given Name 名字Name in Chinese (if applicable) 學生中文姓名 Name on Certificate 證書上的名字 *Please specify the name in English to be printed on the "Certificate of Course Completion" 請提供列印於'修畢課程證書'上的名字Name Tag used in class 上課用之人名牌 *Please indicate the name you would like to be printed on Name Tag used in class 請提供印於課堂用的人名牌上的名字Did you study any courses in our summer programme 2014? 學生曾否參與本中心2014年度之暑期課程? *Yes 有No 沒有If yes, please specify the course you attended in 2014 如有的話，請列出曾參與2014年度之課程名稱 Age 年齡 *Grade completed in July 2015 將於暑假前完成之級別 *P1 小一P2 小二Student's Preferred Language 學生慣用之語言 *Cantonese 廣東話English 英語Mandarin 普通話Cantonese & English 廣東話和英語Mandarin & English 普通話和英語All of the above 以上皆是Sex 性別 *Male 男Female 女Name of your School 學校名稱 *Correspondance Address 住址 *Student's Mobile (if applicable) 學生手機號碼 (如適用) Student's Email Address (if applicable) 學生電郵 (如適用) (2) Course Fee 課程費用Course Fee 課程費用 : HK$2,000 Please prepare a crossed cheque payable to THE UNIVERSITY OF HONG KONG with the applicant's full English name, course code and mobile number at the back of the cheque and send it to Centre for Advancement in Inclusive and Special Education Room 338, Hui Oi Chow Science Building, Faculty of Education, The University of Hong Kong, Pokfulam Road, Hong Kong. Re: HKU CAISE Summer Programme 2015 If the course is cancelled, the applicant will receive full refund. 煩請閣下準備劃線支票，抬頭「香港大學」，支票背部請填上學生姓名，報讀課程編號及聯絡電話一併寄回本中心以完成報名手續。本中心地址如下： 香港薄扶林道香港大學教育學院許愛周科學大樓338室 暑期課程2015 如所報讀之課程取消了，申請人可獲全數退款。Bank 銀行 *Cheque No. 支票號碼 *(3) Parent / Guardian Information 家長/監護人資料Relationship with the student 本人與學生之關係 *Father 父親Mother 母親Guardian 監護人Other 其他Title 稱謂 *Mr. 先生Ms. 女士Mrs. 太太Dr. 博士Prof. 教授Name of Parent/ Guardian (English) 家長/ 監護人之英文姓名 *Name of Parent/ Guardian (Chinese if applicable) 家長/ 監護人之中文姓名 Mobile 手機號碼 *Email Address 電郵 *Confirm your email address again 請再次輸入電郵 *Do you want to receive updates from HKU CAISE? 你想繼續以電郵方式收到本中心的資訊嗎? *YesNo(4) Financial Aid Application 申請助學金Do you need applying financial aid for your child? 貴子女需要申請助學金嗎? *No. I am NOT applying for HKU CAISE Summer Programme 2014 financial aid for my child. 本人不用申請助學金YES, I am applying for HKU CAISE Summer Programme 2014 financial aid for my child. 本人需要為敝子女申請助學金What kind of financial assistance is your child/ family receiving during the year 2014-15? 你的子女或家人在2014 至 15 年度獲得下列哪些資助？ Please submit the financial aid application form with the supporting documents and send us by post. 另請填妥助學金申請表，連同有關證明文件，以郵遞方式寄給我們。Comprehensive Social Security Assistance (CSSA) 綜合社會保障援助（綜援）Full School Textbook Assistance Scheme 全額學校書簿津貼CSSA received per month 每月獲得綜援金額 Does your child have any special needs? 貴子女可有特殊學習需要? *Yes (please specify below) 有（請於下方列明）No 沒有If yes, please specify 如有，請列明 Remarks / Suggestion 備註 / 意見 Verification 驗證碼Please enter any two digits 請輸入任可2個數字 *Example 例 : 12This box is for spam protection - please leave it blank:
