學生報名表格 Application Form for Students

第一部分–個人資料（請以英文正楷填寫）
Part 1–Personal Particulars (Please fill in the form using ENGLISH with block letters)

姓名 Name: (中文Chi) 姓氏   名字	(英文Eng)                    Surname   Given Name
所屬大學 University:  The University of Hong Kong The Chinese University of Hong Kong Hong Kong University of Science and Technology The Hong Kong Polytechnic University City University of Hong Kong Hong Kong Baptist University Hong Kong Metropolitan University Lingnan University Hong Kong Shue Yan University The Hang Seng University of Hong Kong	學生編號 Student no.:
學院 Faculty:  中文 English	現時就讀年級 Current Year of Study: 1 2 3 年級 Year 是否持學生簽証 A student-visa holder: 是 Yes 否 No
主修學科 Major Study:   中文 English	性別 Gender: 男M 女F
出生日期 Date of Birth:	香港身份證號碼(字母及首四個數字) HKID No. (Prefix and first 4 digits): :
國籍 Nationality:	聯絡電話(住所) Residential Tel. No.:
電郵 Email:	流動電話 Mobile No.:
通訊地址 Correspondence Address:
緊急聯絡人 Emergency Contact:	關係Relationship:   電話Tel:

第二部分–實習/工作/義務工作經驗
Part 2–Relevant Experience on Internship/Work/Volunteer Community Services

1. 你有否參與過任何實習計劃? (請按參與日期順序列出最近三項)
Have you ever joined any internship program? (Please place the 3 most recent items in chronological order.)

日期 Date 由From 至 To	實習計劃名稱 Name of Internship Program	工作內容 Responsibilities	機構/公司 Organization/Company
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2. 你有否任何工作經驗 (包括暑期工及兼職)? (請按任職日期順序列出最近三項)
Do you have any previous working experience (including summer employment & part-time jobs)? (Please place the 3 most recent items in chronological order.)

日期 Date 由From 至 To	職位 Position	工作內容 Responsibilities	機構/公司 Organization/Company
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3. 請簡述你過往曾參與的義務工作、課外活動經驗，以及你所負責的工作: (請按參與日期順序列出最近三項)
Briefly describe your past volunteer community service, extracurricular activities experience and your responsibilities:
(Please place the 3 most recent items in chronological order.)

日期 Date 由From 至 To	義務工作、課外活動經驗及角色 Description of the volunteer work, extracurricular activities and your responsibilities	機構/公司 Organization/Company
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4. 你曾否獲得由學術機構、非政府機構或政府機構所頒發的獎項或嘉許? (請按獲嘉許日期順序列出最近三項)
Have your ever received any honors or recognitions awarded by any academies, non-governmental organizations or government departments?
(Please place the 3 most recent items in chronological order.)

日期 Date 由From 至 To	獎項/嘉許 Honor/Recognition	頒發機構 Awarding Organization
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-
-

第三部分–語言/其他技能
Part 3– Language/Other Skills

1. 你書寫語言的熟練程度:
Please indicate your proficiency in the following WRITTEN languages:

英語 English	母語 / Mother tongue 極好 / Excellent 良好 / Good 一般 / Fair 不理想 / Unsatisfactory
中文 Chinese	母語 / Mother tongue 極好 / Excellent 良好 / Good 一般 / Fair 不理想 / Unsatisfactory

2. 你能操的口語言熟練程度:
Please indicate your proficiency in the following ORAL languages:

	說話 Speaking	聆聽 Listening
英語 English (說話能力 Ability to Speak)	母語 / Mother tongue 極好 / Excellent 良好 / Good 一般 / Fair 不理想 / Unsatisfactory	母語 / Mother tongue 極好 / Excellent 良好 / Good 一般 / Fair 不理想 / Unsatisfactory
廣東話 Cantonese (說話能力 Ability to Speak)	母語 / Mother tongue 極好 / Excellent 良好 / Good 一般 / Fair 不理想 / Unsatisfactory	母語 / Mother tongue 極好 / Excellent 良好 / Good 一般 / Fair 不理想 / Unsatisfactory
普通話 Putonghua (說話能力 Ability to Speak)	母語 / Mother tongue 極好 / Excellent 良好 / Good 一般 / Fair 不理想 / Unsatisfactory	母語 / Mother tongue 極好 / Excellent 良好 / Good 一般 / Fair 不理想 / Unsatisfactory

3. 與是次申請相關的其他技能 (如：電腦知識、特別技能等)：
Other information and particular skills you feel are relevant to this application (e.g. computer knowledge, special skills, etc.)

4. 最近學業成績表上顯示的GPA
GPA: GPA as shown on the most recent semester academic transcript: ( ) /滿分 full score : ( )

第四部分–實習工作的意向
Part 4– Preference on Internship

請列出你最有興趣參與的5間實習機構編號以作內部參考，請按此參閱有關實習詳情。閣下的資料將提供予相關實習機構。
Please indicate codes of 5 placement organizations that are of your interest. For details, please click here for relating placement information. Your information will be sent to relevant placement organizations.

志願 Priority	編號 Prog No.	機構名稱 Name of NGO
第一志願 1st priority
第二志願 2nd priority
第三志願 3rd priority
第四志願 4th priority
第五志願 5th priority

第五部分–其他計劃
Part 5– Other Planning

1. 你有否申請CIP 以外的暑期實習計劃？如有，請列出: Have you applied for other summer internship programs except CIP? If yes, please specify:

2.你有否計劃於本年六至八月期間參與其他活動或工作 (例如暑期交流、修讀暑期課程、兼職工作等)？ 如有，請列出: Have you planned to have other commitments during June – August 2022 (e.g. summer exchange, summer semester studies, part-time job, etc)? If yes, please specify:

3. 你有否計劃 /已申請 轉主修科目至非商科學院? 如有，請列出: Have you planned to apply/applied change of major to non-business faculties? If yes, please specify:

聲明 Declaration

本人聲明上述提供的資料正確無誤，並明白如有任何虛報資料或隱瞞重要事實，本人的參加資格可能會被取消。
I hereby declare that, to the best of my knowledge, all information submitted is true and accurate. I understand that should I wilfully provide any false information or withhold any material details in this Application Form, my application may be disqualified.

本人明白並同意，上述資料將交由有關評審委員會作為上述實習計劃面試的參考資料。
I hereby state that I understand and accept that the information given by me above will only be provided to the respective Selection Committee for reference with regards to interviews for the above-mentioned Program.

本人同意報名表格遞交後，如退出是項計劃，須向單位遞交退出申請表。否則，無故退出者將會列入名單並轉交院校備存。
I hereby state that I understand that, I have to submit the official form to the organizer in case I would like to withdraw from the program after the submission of application. Otherwise I will be listed as an unexcused dropout for my school record.

本人明白並同意，必須於指定時間內完成20小時的 CSR 培訓系列及160小時或以上的實習時數，方可獲取實習資助港幣6000元。
I hereby state that I understand and accept that, I have to complete 20 hours of CSR Training Series and 160 hours of internship during designated period in order to received HKD 6000 of subsidy.

本人明白並同意，一經取錄及確認參加是次計劃，必須於三個工作天內簽署合約並須繳付按金港幣1000元，以及出席開幕禮及嘉許禮。
I hereby state that I understand and accept that I have to deposit HKD1000 and sign the contract within 3 working days, as well as the presence of the Launching Ceremony and Recognition Ceremony respectively once I accept the internship offer.

本人明白並同意，如本人能獲選參加上述實習計劃，當計劃完結後，上述資料將會轉交上述實習計劃的畢業生委員會作聯絡用途。
I hereby state that I understand and accept that, if I have been successfully selected to participate in the above-mentioned Program, the information provide by me above will only be given to the above-mentioned Program Alumni Committee for communication.

遞交表格前，請確保已填妥報名表格，並同時附上以下附件：
Please make sure you have completed the Application Form and also attached the following attachments before submitting the form:

由所屬大學工商管理學院教職員填寫的推薦表格 Recommendation Form completed by an academic staff from your Business Faculty.
* 檔案名稱請根據以下的格式。(英文全名_大學簡寫) * Please name your form in this format. (English Full Name_U initial, e.g.ChanTaiMan_UST) * 可於遞交表格後一星期內補交並電郵至 cip@hkcss.org.hk ，請於電郵上註明學生姓名、所屬大學及網上遞交日期，惟補交日期需於實習報名截止日期( 2022年4月14日下午5時正) 前遞交才獲受理。 Recommendation Form can be submitted by email within 1 week after online application form submission. Please email to cip@hkcss.org.hk and state your name, university and online submission date in the email. Please note that the recommendation form will only be accepted before the internship application deadline (14th April, 2022, 5 p.m.).
最近學業成績表副本 Copy of recent academic transcript
500-800字 (英文) 的簡介詳述以下內容： A statement with 500-800 words (in English) that addresses the following: 對將來工作的理想及抱負 Your career aspirations 最希望在哪個服務類別的非牟利服務機構實習及原因 Your most interested aspect of service with a non-profit organization and its reasons 獲得此實習機會的原因 Reasons of deserving this internship opportunity 根據你的性格、態度、學歷、工作技能及專長、興趣等，說明你適合參加此實習計劃的原因? Why your personality, attitude, education background, special work skills and interests are ideally suited for an internship?

私隱聲明

個人資料使用守則 「花旗集團－社聯大學生社責實踐計劃」會盡力遵守及執行《個人資料（私隱）條例》中所列載的規定，確保閣下的個人資料處理得到充份保護，準確無誤，及有妥善的儲存方法。

收集資料目的及使用準則 閣下在本表格內所提供的個人資料將用作「花旗集團－社聯大學生社責實踐計劃」通訊、處理招募、課程、實習、收集意見、研究及活動推廣之用。當閣下確認提交你的資料時，即表示同意所提交的個人資料*將按需要讓本計劃授權職員使用。此外，有關資料可能公開予有關人士 (包括 (包括主辦及贊助機構—花旗集團、合辦機構—香港社會服務聯會、閣下所選擇的實習機構、實習計劃的畢業生委員會) 用以核實資料及聯絡用途。 * 個人資料包括姓名、電話、電郵、身份證號碼 (字母及首四個數字; 用以簽署同意書及核實身份) 、學生編號 (以便與閣下所屬的大學聯絡) 、通訊地址、緊急聯絡人資料

除非我們已取得你的同意，否則我們並不可以使用閣下的聯絡資料提供最新消息和推廣。 本人同意並接受本計劃提供最新消息和推廣。

如欲停止以上用途、要求查閱或更改個人資料，請以郵寄/電郵形式向本計劃職員提出書面通知。 名稱：「花旗集團－社聯大學生社責實踐計劃」 地址：香港灣仔軒尼詩道15號温莎公爵社會服務大厦10樓1002室 電郵：cip@hkcss.org.hk