CTPS-21014 Registration: Unleash from Expectation (S4-S6)(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 Programme 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 attend any courses in our programme 2019/2020? 學生曾否參與本中心2019/2020年度之課程? *Yes 有No 沒有If yes, please specify the programme you attended 如有的話，請列出曾參與之課程名稱 Age 年齡 *Grade 級別 *S4 中四S5 中五S6 中六Gender 性別 *Male 男Female 女Name of your School 學校名稱 *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) Correspondence Address 通訊地址 *District 地區 *Hong Kong Island 香港島Kowloon 九龍New Territories 新界Others 其他(2) Parent / Guardian Information 家長/監護人資料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 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Mobile 手機號碼 *Email Address 電郵 *Confirm your email address again 請再次輸入電郵 *(3) HKU CAISE Scholarship Application 申請香港大學CAISE 獎學金Do you need to apply for the HKU CAISE Scholarship for your child? 貴子女需要申請香港大學CAISE 獎學金嗎? *No. I am NOT applying for HKU CAISE Scholarship for my child. 本人不用申請獎學金YES, I am applying for HKU CAISE Scholarship for my child. 本人需要為敝子女申請獎學金What kind of financial assistance is your child/ family receiving during the year 2020-21? 你的子女或家人在2020-21年度獲得下列哪些資助？ Please submit the scholarship application form with the supporting documents and send us by post. 另請填妥獎學金申請表，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 How did you learn about our programme? 你是從何得知本課程? *Our Centre Website 本中心網頁HKAGE 香港資優教育學院School 學校Facebook 面書Other Parents 其他家長Friends 朋友 By registering now, I agree that any program photos/videos during the program and activities may be used for promotional and archival purposes. I also agree to receive updates from CAISE, Faculty of Education, The University of Hong Kong. I understand that I can cancel my subscription at any time. 本人同意貴機構將課堂及活動情況之照片和錄影作宣傳及存檔用途。本人亦同意繼續接收貴機構之最新消息。本人亦明白可以隨時停止接收相關資訊。 *I understand and agree with the above statement. 本人明白並同意上述之描述。 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:
