The Center for the Development of The Gifted and Talented



Enrichment Program for Gifted Learners (Summer 2018)

優才增益課程（2018年夏季）

Course Enrolment Form 課程報名表

|Application Details報名詳情 |

|Course Details |Please visit　請參閲： |

|課程資料 | |

|Application Period |26 March (Mon)　–　7 May, 2018 (Mon) |

|報名日期 |2018年3月26日（星期一）　至　5月7日（星期一） |

|Application Procedure |Online Application 網上報名（）： |

|報名程序 |Complete the application form and upload relevant documents online. 於網上填寫報名表及上載相關文件。 |

| |OR 或 |

| |Submit the following documents on or before the application deadline (postmarked date) to the address below於截止報名日期或之前（以 |

| |郵戳為準）把下列文件郵寄至以下地址： |

| |Completed Course Enrolment Form 填妥的課程報名表 |

| |All documents (including the most recent School Academic Report (required), copies of document certifying applicant’s academic |

| |competence (if any)) 相關文件（包括最近期之學校成績表副本（必須）、申請人學術能力的證明文件（如有）等） |

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|Application Result |Application result will be released via email on 13 June, 2018 (Wed). Upon receiving the email, successful applicants should pay the|

|申請結果 |course fee by cheque or bank-transfer within three working days. |

| |成功申請結果將於2018年6月13日（星期三）以電郵通知。獲取錄報讀課程的申請者須於三個工作天內以支票或銀行方式繳交課程學費。 |

|Important Notes |Course fees are not refundable except for unsuccessful applications. Please beware and avoid time clash between any other courses |

|重要事項 |and activities. After the announcement of result, no course fees will be refunded, transferred or retained under any circumstances. |

| |除報名未獲接納外，已繳費用，概不退還。請留意課程的上課日期和時間是否與申請人其他課程或活動時間重疊，如報名獲接納，已繳費用概不退還，|

| |亦不可轉讓或保留至下期課程。 |

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| |Make-up lesson will not be provided except for cancellation of classes due to adverse weather conditions. CDGT and HKUST will have |

| |full discretion on fixing the date, time and venue of the make-up lessons. If any student is unable to attend, no |

| |refund/compensation in any form nor further make-up lesson will be arranged. |

| |如參加者缺課，恕不另行作個別補課。若因惡劣天氣取消課堂，則會安排補課。補課日期、時間和地點由資優教育發展中心及香港科技大學全權決定。|

| |若學生未能參加補課，將不獲任何形式的退款或補償，亦不會為個別學生另行安排補課。 |

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| |Please ensure your application bears sufficient postage before posting. (The revised principal postage rates have taken effect on 1 |

| |January 2018, please note.) |

| |請確保已付足夠郵費，否則報名表無法送達本中心。（經調整的郵政收費已於2018年1月1日生效，敬請留意。） |

|Enquiries 查詢 |Tel電話： (852) 2358 5084 Fax傳真：(852) 2358 2201 Email電郵：cdgt@ust.hk Website網址：cdgt.ust.hk |

|Application Form報名表格 |

|Please fill in the form in Chinese or English in BLOCK letters and put a ( in the boxes where appropriate. |

|請以中文或英文正階填妥以下資料，並在適當處加上 ( 號。 |

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|Course Enrolment 報讀課程 |

|Please indicate your preference in the box(es) provided. You can choose up to THREE preferences, and selection will be based on your indicated priority. If you|

|wish to take two courses at the same time, the 1st and 2nd priority will be considered simultaneously. Eligible applicants will only be admitted to at most TWO|

|of the courses. |

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|請根據你希望入讀各課程的優先次序，填寫下表，最多可選三個意願。遴選將會根據填報的優先次序進行。如你希望同時修讀兩個課程，則第一及第二意願將獲同時考慮。合資格的 |

|申請人只會獲安排入讀最多兩個課程。 |

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|Session |

|報讀組別 |

|Primary 小學組　　　 Secondary 中學組 |

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|Number of courses enrolling |

|擬就讀課程數目 |

|ONE course 一個課程　　 TWO courses 兩個課程 |

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|Preference |

|意願 |

|Course Code |

|課程編號 |

|Course Name |

|課程名稱 |

|Course Fee* |

|學費金額* |

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|* If you wish to apply for the Financial Assistance Scheme, please write down the amount AFTER subsidy. |

|For details, please refer to Part D of this form. (Not applicable to course M106.) |

|如你希望申請「學費資助計劃」，請寫上獲減免後的金額。詳請請參閱本表格D部。（不適用於報讀M106課程） |

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|How did you learn about EPGL Program? 你從哪些途徑知道優才增益課程消息？ |

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|   Friends 朋友 |

|   School – Poster 學校 – 海報 |

|   School – Email學校 – 電郵 |

|   HKAGE 香港資優教育學苑 |

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|   Website 網頁 |

|   Facebook |

|   CDGT Email 本中心宣傳電郵 |

|   HKUST Alumni Newsletter 科大校 |

|友通訊 |

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|   UST Staff Newsletter 科大教職員協會會訊 |

|   Others 其他（please specify 請列明：_________________________） |

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|Personal Particulars 個人資料 |

|Please make sure that the information given is correct as all the important notices will be sent according to the information |

|provided.　所有重要消息均按照以下填寫的資料通知同學，敬請確保所填資料正確無誤。 |

|Surname in English |Given Name in English |Surname in Chinese |Given Name in Chinese |Gender |

|英文姓氏 |英文名字 |中文姓氏 |中文名字 |性別 |

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|(English name will be printed on Certificate. 英文姓名將印於課程證書上。) | | | |

|Date of Birth出生日期 (dd-mm-yyyy) |Residential Phone No. 住宅電話 |Student Mobile Phone No. 學生手提電話 |

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| | |( Please put a tick if you wish to receive |

| | |information /notices via SMS 如你希望以短訊收取課程 |

| | |消息，請加上( 號 |

|HKID No. 香港身份證號碼 | | |

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|Student E-mail Address (All important notices will be sent by email. Please write down CLEARLY an active address.) |

|學生電郵地址（重要消息會以電郵通知，請清楚填寫常用的電郵地址。） |

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|Correspondence Address (Course Certificate will be sent by post. Please write down CLEARLY a complete address.) |

|通訊地址（課程證書將以郵遞送出，請清楚填寫一個完整的地址。） |

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|Name of School Attending 就讀學校 |

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|Level Attending (at the time of application) 就讀年級（於報名時） |

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|Example例子：(P4/Y5/G4); (P5/Y6/G5); (P6/Y7/G6); (S1/Y8/G7) |

|Have you ever skipped a grade at school? 你有否曾經於學校跳級？ |

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|Yes有（Year跳級年份：       　From由  　       to 跳至      　  study level 年級） |

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|No 否 |

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|Have you ever enrolled in any CDGT’s DP/EPGL courses? 是否曾經就讀本中心舉辦的雙修課程／優才增益課程？ |

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|Yes 有 |

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|CDGT Student ID (if any) |

|學生編號（如有） |

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|Year of latest course attending |

|最後就讀課程的年份 |

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|Course(s) you attended |

|曾就讀之課程 |

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|No 否 |

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|Parent’s / Guardian’s Information家長／監護人資料 |

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|Surname in English |Given Name in English |Surname in Chinese |Given Name in Chinese |

|英文姓氏 |英文名字 |中文姓氏 |中文名字 |

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|Relationship 與學生之關係 |Emergency Contact No. |E-mail Address 聯絡電郵 |

|      |緊急聯絡電話 | |

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|Financial Assistance Scheme (Except M106 Blended Learning in Mathematics) |

|學費資助計劃（M106「網上學習 — 數學」除外） |

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|Successful applicants are entitled to 50% subsidy of the course fee. |

|成功申請者可獲減免五成學費。 |

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|Do you wish to apply for the Financial Assistance Scheme? 是否申請「學費資助計劃」？ |

|Yes是 No 否 |

|Applicant should submit: |

|a VALID copy of proof of Comprehensive Social Security Assistance (CSSA) OR School Textbook Assistance Scheme (Full or Half Grant) |

|CDGT reserves the right to reject any applications that are unable to present valid proof. |

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|申請者須於提交報名表時附上： |

|於本學年成功申請綜合社會保障援助計劃 或 學校書簿津貼計劃（全額或半額津貼）之有效證明文件 |

|本中心有權拒絕任何未能提交有效證明文件之申請。 |

|Applicants with Special Learning Needs 特殊學習需要 |

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|Do you need special arrangement in learning and/or participating in course assessments? |

|在學習上或參加課程考核時，你是否需要特別的協助或安排？ |

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|Yes 需要（Please specify below. You may consider providing medical certificate(s) or educational psychological report(s) as supporting documents 請提供詳細資 |

|料，有需要可提交醫生證明書或教育心理學家評估報告）： |

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|____________________________________________________________________________________________________________ |

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|No 不需要 |

|Academic Background and Additional Information 學歴及附加資料 |

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|In the table below, please provide information of no more than three examinations/competitions/events relevant to each of the subject area of the course(s) you|

|are applying and provide copies of certificates/proofs (if any). Selection will be based on information submitted. You may use extra paper if necessary. |

|請就每個報讀課程／科目填寫最多三項與所報讀的科目相關的考試、比賽或活動資料，並提供證書或學術能力證明文件副本（如適用）。本中心將根據學生提交之資料進行遴選。如 |

|有需要，可另行加紙書寫。 |

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|Date (MM/YY) |

|日期 (月份／年份) |

|Name of Examination / Competition / Event |

|考試、比賽或活動名稱 |

|Issuing Organization |

|頒發機構 |

|Grade / Award Obtained |

|獲頒獎項或成績等級 |

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|To 至 |

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|Important Notes 注意事項 |

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|Please make sure that the Course Enrolment Form has been duly completed and all documents (including the most recent School Academic Report, copies of document|

|certifying applicant’s academic competence) have been enclosed for application. Incomplete application forms will not be processed. Late applications will not |

|be considered. |

|申請人應確保已填妥報名表格及提交所有文件（包括最近期之學校成績表副本、申請人學術能力的證明文件（如有）），否則本中心將不辦理有關申請。逾期申請恕不獲考慮。 |

|Personal data provided are used by the Center for the Development of the Gifted and Talented (CDGT) only for purposes of enrolment, student administration, |

|research and educational purposes. All submitted documents will not be returned. |

|申請人所提供的資料，本中心只用作處理報名丶學生事務丶研究及教育用途。所有已遞交之文件均不獲退回。 |

|Successful applicants should pay the course fees by cheque or bank-transfer within three working days. Applications will be deemed cancelled if applicants fail|

|to pay on or before deadline. Only crossed cheques or bank-transfer are accepted. Please do not pay by post-dated cheques, postal orders or cash. |

|獲取錄報讀課程的申請者須於三個工作天內以支票或銀行轉帳方式繳交學費。未能於限期前繳交學費的申請者其報名會視作放棄論。本中心只接受劃線支票或銀行轉帳方式繳交學費 |

|，請勿使用期票丶郵政匯票或現金繳交學費。 |

|Applicants should meet the admission requirements of each course. For details, please refer to individual course description. |

|申請人應符合所報讀的課程的最低入學要求，詳情請參閱個別課程簡介。 |

|All fees paid are non-refundable, non-transferable, and non-retainable. |

|所有已繳交之學費均不可退還、轉讓或保留至下期課程。 |

|CDGT reserves the right to make any alterations to the courses as deemed necessary. CDGT also reserves the right to cancel a course due to insufficient |

|enrolment or other unforeseen circumstances, in which case full course fees will be refunded. |

|本中心保留在有需要時更改課程內容、上課日期、時間、地點及導師之權利。若課程報名人數不足或在特殊情況下，本中心有權取消該課程，並退還全數學費。 |

|Certificates will be issued to students who have completed the course successfully. For details, please refer to individual course description. |

|凡成功通過各項評估及出席率達到一定標準的學員將可獲發證書乙張，詳情請參閱個別課程簡介。 |

|Under no circumstances will the University be liable for any accident, losses, and injuries or any other expenses incurred resulting from the attendance at, or|

|participation in any of the activities offered by CDGT. |

|香港科技大學、課程導師及本中心職員概不負責學員因出席或參與各項課程所引致之意外、損失、受傷、疾病或其他支出。 |

|Declaration 聲明 |

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|Personal data provided in this form will be used for course application and research purposes, for both CDGT and other related departments within HKUST and |

|other organizations and agencies authorized where necessary. Under normal circumstances, personal data of unsuccessful candidates will be destroyed within 24 |

|months upon rejection of application. |

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|CDGT will use your personal data (in particular your name, contact, and background information) in order to communicate with you regarding various activities |

|organized by CDGT and the University, including the promotion of events, seminars, programs, training, fund raising, support for special initiatives, etc. Your|

|consent is required for this communication practice. |

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|* If you wish to update your personal data, or cease receiving our communications, please email us at cdgt@ust.hk. |

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|申請人提供的個人資料只用於課程申請（例如資格核實）及教育研究，包括本中心以及獲授權處理有關資料的本大學部門及其他機構、組織。在一般情況下，未獲取錄的同學的個人 |

|資料將於公布申請結果後24個月內全部銷毀。 |

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|本中心擬使用閣下提供的個人資料（主要包括姓名、聯絡方法及個人背景資料），以提供有關本中心及大學的任何講座、課程、培訓、籌募及其他活動推廣資訊。惟我們必須先得到 |

|你的同意，否則不能如此使用你的個人資料。 |

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|* 如你日後希望更改個人資料，或停止接收上述資訊，請電郵至 cdgt@ust.hk 通知我們。 |

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|******************************* |

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|The applicant and his/her parent(s)/guardian(s) agree CDGT and the University to use my personal data for communication with me regarding various activities |

|organized by CDGT and the University, including the promotion of events, seminars, programs, training, fund raising, support for special initiatives, etc. |

| |

|The applicant and his/her parent(s)/guardian(s) agree for CDGT and the University to use the workshop/class photos for promotion. |

|I declare that the information provided is true and correct. The applicant and I have read and understood the Regulations set out by CDGT, and hereby sign to |

|indicate my unreserved agreement with all its contents. |

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|申請人及家長／監護人同意資優教育發展中心及香港科技大學使用所提供的個人資料，以提供有關本中心及大學的任何講座、課程、培訓、籌募及其他活動推廣資訊。 |

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|申請人及家長／監護人同意資優教育發展中心及本大學使用活動當日／課堂的照片作宣傳推廣之用。 |

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|本人謹此聲明上述所提供之資料均屬正確。申請人及家長／監護人已清楚閱讀及明白資優教育發展中心所訂出的課程規則，並贊同其所有內容。 |

|Signature of Applicant’s Parent/Guardian 家長／監護人簽署： |Date 日期： |

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|Checklist: Documents Required 文件清單：所需文件 |

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|Please check the box(es) to indicate the documents submitted. 請選擇以下項目以示已準備所需文件。 |

| Course Enrolment Form 課程報名表格 |

| Copies of most recent School Academic Report (Required) 最近期之學校成績表副本（必須） |

|If any: Copies of any other document certifying applicant’s academic competence (SAT, World Class Tests or other academic competence) |

|如有：申請人學術能力的證明文件（SAT、世界數學測試成績、或任何其他比賽或測試證明文件） |

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|Applying for the Financial Assistance Scheme (not application to course M106) |

|如需要申請學費資助計劃（M106課程除外）： |

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|Copy of application result of School Textbook Assistance Scheme OR certificate of Comprehensive Social Security Assistance |

|學校書簿津貼計劃／綜合社會保障援助計劃申請結果通知書副本 |

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The Center for the Development of the Gifted and Talented (Room 6595)

The Hong Kong University of Science and Technology

Clear Water Bay, Kowloon, Hong Kong

(Remarks: Please state “Application for EPGL” on the envelope)

香港九龍清水灣香港科技大學6595室

資優教育發展中心

（備註：請於信封面註明「報讀優才增益課程」）

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