Engineering Day Camp for Secondary School Students 2015 Application Form Notes to the applicants  Please read the application procedures as listed on the following website carefully http://www.hkie.org.hk/2015daycamp  For application for the Engineering Day Camp for Secondary School Students 2015, please submit the followings to the HKIE Secretariat by email or mail: 1) The completed Application Form; 2) Self-introduction in about 200 words; 3) Copies of recent academic report; and 4) A letter of recommendation by school (if applicable)  Deadline for submission: Friday, 30 January 2015  Should you have any enquiries, please contact the HKIE Secretariat Telephone : 2895 4446 Email : [email protected]/ [email protected] Address : 9/F Island Beverley, No 1 Great George Street, Causeway Bay, Hong Kong Part I Personal Particulars (To be completed by the applicant) Name in Full (English) Gender M/F* (Chinese) Date of Birth (DD/MM/YY) HKID (First 4 digits/ characters) Correspondence Address Contact Phone No. (Home) School Email (Mobile) Class Do you have any special health conditions that require our attention? (If yes, please specify) Part II Self-Introduction (To be completed by the applicant) Please briefly introduce yourself and your interest areas in engineering in about 200 words on a separate A4 sheet. Part III Principal/ Teacher* Endorsement (To be completed by school) I recommend _______________________________(Name of student) of ___________ (Class) to attend the Engineering Day Camp for Secondary School Students 2015 co-organised by the Hong Kong Institution of Engineers and the Hong Kong University of Science and Technology. Name of Principal/Teacher* Date Signature of Principal/Teacher* with school chop □ A letter of recommendation is attached. □ No letter of recommendation is attached. Please put a tick in the box as appropriate * Please delete as appropriate 1 Engineering Day Camp for Secondary School Students 2015 Part IV Parent Consent (To be completed by the applicants’ parent/ guardian) I, __________________ (name in BLOCK LETTER), parent/guardian* of ____________________(name of the student) of _________________(name of the school), hereby agree my son/daughter* to participate in the Engineering Day Camp for Secondary School Students 2015 co-organised by the Hong Kong Institution of Engineers and the Hong Kong University of Science and Technology on 7 April 2015. I certify that the health condition of my son/daughter* is suitable for the camp. 第四部份家長/監護人同意書 (此部份由家長/監護人填寫) 本人 _________________（中文姓名以正楷填寫），為 _______________(學校名稱)學生_____________________(學生姓名) 之家長/監護人*，同意及確定子弟／子女*的健康狀況適宜參加由香港工程師學會及香港科技大學聯合舉辦的中學生工程體驗日營 2015。 Name of Parent/Guardian 家長/監護人姓名 Signature of Parent/Guardian 家長/監護人簽署 Emergency Contact No. 緊急聯絡電話 Date 日期 *Please delete as appropriate Part V Declaration (To be completed by the applicant) 1. I declare the information set out in this application or any attachment is, to the best of my knowledge, accurate and complete. 2. I agree to the data provided in the application form will be used as a basis for selection of applicants and for admission for the day camp; as evidence for verification of the applicant’s identity, examination results, academic records and other information by the HKIE or HKUST. 3. I give my consent to the use of my photos/images taken at the Camp for promotional purpose of the organisers in the future. _________________________ Signature of Applicant __________________________ Date Data Usage: Under the Personal Data (Privacy) Ordinance, you have a right to request access to, and to request correction of, your personal data in relation to your application. If you wish to exercise these rights, please contact the HKIE Secretariat at 2895 4446. 2