A1
TWGHs Lee Ching Dea Memorial College 東華三院李
                    潤田紀念中學
                    Application For Admission 申請入學
                                                                          校務處專用/Office Use Only
                                                                          Rejected / Waiting List / Admitted
                                      中文姓名/Chinese Name:
英文姓名/Name:
                                                                          By :                   , Date :
         LI Junxin
                                                                          Rejected / Waiting List / Admitted
                                      性別/Sex:          男M / 女F
其他姓名/Other Name:
                                                                          By:                       ,
                                                                          Date :
出生地點/Place of Birth:                  出生日期/Date of Birth:                 Rejected / Waiting List / Admitted
                                               (dd)/     (mm)/            By:                        ,
                                      (yy)      21/01/09                  Date :
                                      申請入讀級別/Form Applied For: 個人資料 Personal Information
年齡/Age:       16
                                      手提電話/Mobile Phone:
聯絡電話/Phone:
   47030197                             47030197
電郵/email address:      13910298895@139.com
地/省/市       入學日期             離校日期                                學校                                         級別
Region   Date of Admission Date of Departure                     School                                     Form
           09/16
             /               07/21
                               /
           09/21
             /               07/24
                               /
               09/24
                 /      /
                     07/25
                    學生住址 (請盡量以英文填寫此欄) Address (Please write in English if possible)
 室/Flat        T                           樓/Floor                  1           座/Block
 大廈/Building
 村/屋村/Village / Estate
 街道名稱及號碼/Street & no.
 地區/District
 最近 6 年就讀學校(包括小學) Name of Schools attended in the last 6 years (including Primary School)
                                                                  *家⾧或監護人資料/Guardian s Particulars
英文姓名/Name:            LIHengyuan                           中文姓名/Chinese Name:
       13911386039@139.com
電郵/email:                                                  手提電話/Mobile Phone: +8613911386039
與學生關係/Relationship:父/母/其他 ______________________ Father / Mother / Other _______________________
            畢業/就讀於本校之直系親屬/Parents or siblings graduated from/studying in our school
                        姓名                                      與申請人關係               畢業年份/現時就讀班別
                       Name                                      Relationship        Year of Graduation/Class
*必須填寫家⾧聯絡電話、電郵地址,以便本校與家⾧聯絡。Please provide the parent’s contact phone number and
email address for the purpose of the school being able to contact them.
*本表格所收集的個人資料,將用以辦理申請學位事宜。本校可能會將這些資料披露予教育局或其他獲授權處理個人資料的
學校,用以處理學位分配或其他有關教育的事宜。The personal information collected in this form will be used for the purpose of
processing application matters. The school may disclose this information to the Education Bureau for the purpose of handling place
allocation or other related matters.
*填表人有權按《個人資料(私隱)條例》第 18 和 22 條及附表㇐第 6 原則的規定,查閱及改正個人資料。查閱資料的權利,包
括取得本表格/紀錄所載個人資料的副本。如有需要,請致電 25715422 向本校行政主任查詢。You have a right of access and
correction with respect to your personal data pursuant to Section 18, 22 and Principle 6 of Schedule 1 of the Personal Data (Privacy)
Ordinance. Your right of access includes the right to obtain a copy of your personal data held by us. Please call 25715422 to inquire
with the school execute officer if necessary.