Application Form for Student Residence - Page 2 of 2

學生宿舍申請表 (只限本科生)
Application Form for Student Dormitory (for Undergraduate Students only)

**Note 1: Applicants are advised to read the “Student Residence 2020-21 Application Guide” and “Student Residence 2020-21 Rules and Regulations”. carefully before submitting their applications.
提示一：在遞交申請表前，申請者需詳閱「學生宿舍 2020-21 學年申請須知」及「宿生守則 2020-21」Note 2: Required fields are indicated with *
提示二：以* 標示之欄位必須填寫

申請人資料 Applicant’s Information

英文姓名：
Name in English *

學生編號：
Student No. *

中文姓名：
Name in Chinese

性別：
Gender *
男 Male女 Female

聯絡電話 Contact No：

手機：
Mobile *

住宅:
Home

學生電郵:
Student Email:*

@student.chuhai.edu.hk

近照 Recent photo: *
(<600KB, Format: PNG, JPG)

房間選擇 Type of Room：*

首選First choice
雙床房 (單人床) 2-Bed (Single Bed)三床房（單人床及高低床）3-Bed (Single Bed and Bunk Bed)

次選Second choice
雙床房 (單人床) 2-Bed (Single Bed)三床房（單人床及高低床）3-Bed (Single Bed and Bunk Bed)

Please be aware that SAO may offer you the second choice when first choice could not be entertained.
學生事務處將因應宿位情況安排首選或次的房間予同學

宿舍經歷 Dorm Experience：*

本人從未居住於學生宿舍 I have never stayed in the dormitory本人曾居住於學生宿舍 I have stayed in the dormitory

如曾居住於學生宿舍，請註明居住的學年及學期
If you have stayed in the dormitory, please specify the period

離校距離 Distance from home to college*

現時居住於香港 Currently living in Hong Kong現時没有居住於香港 Currently not living in Hong Kong

現時居住地址:
Current Residential Address

香港島 Hong Kong Island九龍 Kowloon新界 New Territories離島 Island其他 Others

地址証明文件
Address proof: (<2MB, Format: PNG, JPG)

申請人必須遞交一份最近三個月並附有申請人姓名之住址證明副本。
非在宿生: 銀行月結單、租約等。若沒有，可遞交同住父母之住址證明副本，如：水費單，並連同出生證明文件副本一併遞交。
在宿生: 宿生証副本或 2019-20下學期宿費收據副本或 2019-20下學期宿費付款通知書副本
Applicants MUST submit a copy of residential address proof document issued within the last 3 months bearing the applicant’s name.
Applicants currently not staying at dormitory : e.g. bank statements, tenancy agreement. Applicants may also submit their parents’ residential address proof, such as a utility bill, together with a copy of applicant’s birth certificate.
Applicants currently staying in dormitory : Copy of resident card OR Copy of 2019-20 semester 2 residence fee receipt OR Copy of 2019-20 semester 2 residence fee debit note
如申請人未能提供住址證明，學生事務處將不會處理有關申請。
The SAO will NOT process the application without receiving a residential address proof.

出生證明文件 (如適用)
Birth certificate (if applicable): (<2MB, Format: PNG, JPG)

回校所需時間 (分鐘):
*在宿生請填 "0" :
Travelling Time to College (Minutes)
* Students currently living at the dormitory please fill "0" *

請按運輸署香港乘車易最快之交通時間為標準
Please refer to the shortest travelling time as listed on the “Hong Kong eTransport”
網址 URL Link: hketransport.gov.hk

參與職務 Positions / Participation*

參與職務
Current Position
沒有 N/A學生會 Student Union (SU)各系幹事會 Academic Associations學生會屬會 Interest groups under SU其他 Others

請列明所屬學會及職銜 Please indicate the name of association and position:

請附上擔任上述職務的證明文件或「非學術成就」証明書

Please submit any supporting documents or non-academic achievement certificates (scanned copy with appropriate signature and chop) if you have chosen any of the above / participations.
(<2MB, Format: PNG, JPG)

升讀年級 Year to Promote

2020-21 學年升讀年級
Year to promote in 2020-21 academic year *
一年級 Year 1二年級 Year 2三年級 Year 3四年級 Year 4

額外奬勵分數 Bonus Point for Outstanding Performance

2019-20上學期成績
Term GPA of 2019-20 first semester*

請附上成績證明文件
Please provide academic record.*
(<2MB, Format: PNG, JPG)

你曾否在院長/校長榮譽名單上?
Have you been on the Dean’s List/President’s List? *

有 Yes沒有 No

如選有請註明年份
If Yes, please specify the Year

奬項 / 校內或外義工服務 (如有)
Awards / on or off campus voluntary service (if any)

請附上證明文件
Please attach any supporting documents.
(<2MB, Format: PNG, JPG)

健康理由 (如適用) Health Reasons (If applicable)

(註：請附上由醫生發出的證明文件。)
(Note: Please attach any supporting documents from a medical practitioner.)

醫生發出的證明文件

Supporting documents from a medical practitioner: (<2MB, Format: PNG, JPG)