Fillable Grantham Scholarships Fund Photograph NOMINEES PERSONAL PARTICULARS FORM (Workplace English Campaign)

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Grantham Scholarships Fund Photograph NOMINEES PERSONAL PARTICULARS FORM (Workplace English Campaign)

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Country of origin: HONG-KONG
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Grantham Scholarships Fund
2020-21 “Grantham Scholars of the Year” Award
1
NOMINEE’S PERSONAL PARTICULARS FORM
2. Name in Chinese :
4. Date of birth (DD/MM/YY):
(First four digits)
1. Name in
English :
3. HK ID card no.:
5. Contact tel no.:
6.
Length of residence in HK :
)
7. E-mail address :
8. Residential address :
9. HKDSE / IB / Other public examination results* (*please specify:
(please list your six best subjects, includes all core subjects for HKDSE) :
Subject
Grade
Subject
Grade
Subject
Grade
Subject
Grade
Subject
Grade
Subject
Grade
10. Please provide details of maximum of 6 items of internal extra-curricular
activities in the past three academic years.
(Nominees should make reference to their SLP when completing the information.)
Student Union/ Prefect Team
Name
To (MM/YY)
Highest position
Clubs, House, School Teams and School Activities
Name
To (MM/YY)
Highest position
Uniformed Service Groups
Name
To (MM/YY)
Highest position
POINTS TO NOTE
The following documents should be submitted by the nominating school together with this form:
(i) Nomination Form;
(ii) A copy of nominee’s
public examination results certified true by the nominating school
principal; and
(iii) Student Learning Profile ("SLP").
Please be advised to make a photocopy of the completed form and relevant documents
for own reference. Any request for amendment of information will not accepted once
the nominations are submitted. Nominations are deemed to be unsuccessful if the nominating
school has not been notified by March 2021. Deadline for submission: 18 December 2020
Photograph
Official use only
Nomin
ation no:
GSF-GSY-2021-
(Surname)
(Given Name)
Grantham Scholarships Fund
2020-21 “Grantham Scholars of the Year” Award
2
11.
Please list maximum of 12 items of community service provided, excluding those listed in item 10 extra-curricular
activities above, from senior secondary 1 onwards.
(Nominees
should make reference to their SLP when completing the information.)
Name of Organization Nature of service
Period of service rendered
(MM/YY)
(i)
From to
(ii)
From to
(iii)
From to
(iv)
From to
(v)
From to
(vi)
From to
(vii)
From to
(viii)
From to
(ix)
From to
(x)
From to
(xi)
From to
(xii)
From to
12.
Please state your current study institution and programme, and describe your future career plans.
Grantham Scholarships Fund
2020-21 “Grantham Scholars of the Year” Award
3
13. Please indicate the language you prefer to use in the interview:
(Students are not allowed to change the chosen language upon submission of this Form)
(Please put a “” in the appropriate box)
☐English* (please proceed to item 15) ☐Cantonese** (please proceed to item 14)
:
☐E
: ☐E
15. I declare the information in this form and the supporting documents provided by me are true, complete and accurate.
I have read th
e ‘Notes about Personal Data’ attached to this form, and I consent to the disclosure of any information
contained in this form to other Government bureaux and departments for the purpose of processing the nomination. If
I am being selected as “Scholar of the Year”, I also consent to the publication of my name, photos, public examination
results, extra-curricular activities and community services in any form as the Grantham Scholarships Fund Committee
shall think fit.
Nominee’s Signature :
Date :
*
Students are required to use English
** Students choosing Cantonese must choose a different
throughout the whole interview.
language for each of the following two parts:
(i) Self-introduction & short speech; and
(ii) Conclusion
14. If "Cantonese"
has been chosen in item 13, please indicate the language you prefer to use for Self-introduction & short
speech and Conclusion:
(Students are not allowed to change the chosen languages upon submission of this Form)
(Please put a “” in the appropriate box)
(i) Self-introduction & short speech on a given topic nglish ☐Mandarin
A different language must be
chosen for (i) and (ii)
(ii) Conclusion
nglish ☐Mandarin
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Grantham Scholarships Fund
2020-21 “Grantham Scholars of the Year” Award
NOMINATION FORM
1.
I,
, Principal of
,
(School’s name)
wish to nominate
of this school to compete for the
(Name of applicant)
2020-21 “Grantham Scholars
of the Year” Award.
2.
My comments on the above-mentioned student are as follows :-
(i)
Academic achievements :
(ii)
Character and overall capabilities :
(iii)
Participation in extra-curricular activities :
(iv)
Participation in community services :
(v)
Conduct and any other comments :
3.
I
hav
e read th
e
‘No
t
es about Personal Data’ attached to this form, and I consent to the disclosure of any
information contained in this form to
o
ther Gov
ernment bur
e
a
u
x and departments for the purpose of processing the
nomination.
Signature
:
School Address
:
School Chop
Region :
☐ ☐ ☐
HK
KOWLOON *
NT/ISLANDS
Teacher-in-charge:
Telephone No.
:
E-mail Address
:
Fax No.
:
Date
*According to the classification of Regional Education Offices in Education Bureau, Kowloon region
includes schools in Sai Kung District.
Grantham Scholarships Fund
2020-21 “Grantham Scholars of the Year” Award
Notes about Personal Data
Purpose of completing the Form
The provision of personal data is entirely voluntary. However, if information provided is found
insufficient, the Secretariat may not be able to process the nomination for the “Grantham Scholars
of the Year” Award.
2. The names, photos, public examination results, extra-curricular activities and
community service of the awardees may be published for the purposes mentioned in paragraph 1(b)
above.
Classes of
Transferees
3. The personal data provided in the form may be disclosed or transferred to subject
officers of other Government bureaux and departments for the purposes mentioned in paragraph 1
above. Please state the sensitive personal data in the form that you do not like to be disclosed or
transferred to Government bureaux and departments.
Access to Personal Data
4. Pursuant to sections 18 and 22 and Principle 6 of Schedule 1 of the Personnel Data
(Privacy) Ordinance (Cap. 486), the nominee has the right to request to access to and correction of
personal data held by the Secretariat. The nominee’s right of access includes the right to obtain a
copy of the personal data collected in the form.
Retention of Personal Data
5. The nomination form will be generally retained for 7 years for audit purpose and the
form will be destroyed thereafter.
Enquiries
6. Enquiries concerning the personal data collected in the form, including the access and
corrections, should be addressed to :
Assistant Manager (Trust Funds)
34/F, Wu Chung House
213 Queen’s Road East, Wanchai,
Hong Kong
1. The personal data collected in the form will be used by the Grantham Scholarships Fund
Secretariat (“the Secretariat”) for the following purposes:
(a) activities relating to “Grantham Scholars of the Year” Awards assessment;
(b) publicity and ceremonies relating to the “Grantham Scholars of the Year” Awards;
and
(c) communication between the Secretariat and the nominees / the schools.
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Grantham Scholarships Fund Photograph NOMINEES PERSONAL PARTICULARS FORM (Workplace English Campaign)

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Completed 23 November 2020

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