Application Form

Please complete all relevant parts in BLOCK LETTERS.

1. Personal Particulars Please tick as appropriate.

Chinese Name (if appropriate): Gender:

Date of Birth (Day / Month / Year): Mobile:

HKID Card No: Tel. No. (Home):

Correspondence Address:

Room / Flat Floor Block, Building

Estate, Street / Road District (e.g., Wan Chai, Kwun Tong, etc.)

HK KLN NT

Personal Email: Company Email:

Where did you FIRST learn about the course?

Email Centennial College website Facebook Employer Friends Direct mail by post

LinkedIn Mobile apps Centennial College’s events Referral from Radica Others:

Received on: ____________

Handled by: ___________

Admitted

Rejected

Waiting List

2. Course Fees

Module 4 (Optional)

Apply Module 4 at only $1,420 for those who enroll in Module 1-3. (Module 4 is not a stand-alone course. Enrolment in Module 1-3 is a prerequisite for taking Module 4.)

Add: HK$150 non-refundable application fee HK$150

Total course fees HK$

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Male Female

Special Price

Enrolment of Module 1-3 and Module 5 at one timeEnrolment of Module 1-5 at one time

Module 1-3

HK$ 9,900

HK$ 9,900

HK$ 1,420

HK$ 11,000

Early Bird, less 10% (Enrolment received on/ before 30 Mar 2018)

Centennial College's alumni or staff; Radica's staff or clients, less 10%

Discounted price

Module 5 (Optional)

HK$ 5,400HK$ 5,400

HK$ 15,300HK$ 16,000

Early Bird, less 10% (Enrolment received on/ before 30 Mar 2018)

Centennial College's alumni or staff; Radica's staff or clients, less 10%

Discounted price

HK$ 6,000

4. Payment Methods

Cheque Bank draft Cash deposit

Academic Institution Title of Award Year of Award Full Time / Part Time

Professional Body Title of Award Year of Award

7. Employment History (in chronological order)

Date (From / To) Name of Employer Job Title Full Time / Part Time

8. Other Information Relevant to This Application (Please use a separate sheet if necessary)

9. Other Relevant InformationIt is the College policy to offer equal opportunities to all applicants with or without disabilities. To enable us to meet the needs of all students, you are invited to indicate on this form whether you require any special assistance. If you do need such assistance, the College may approach you subsequently to obtain further details so as to facilitate our planning and assess how best we can help you. Special assistance required Yes No

3. Course Schedule

Course Title Module 1-3

Date

Time

Time

21 Apr 2018(Sat) 28 Apr 2018 (Sat), 5 May 2018 (Sat) 12 May 2018 (Sat)

Venue To Be Confirmed HKU SPACE, Admiralty Centre, 18 Harcourt Raod,Hong Kong (Exit A, Admiralty MTR Station)

Course Title Module 4 (Optional) Module 5 (Optional)

Date 19 May 2018 (Sat) 9 Jun 2018 (Sat), 16 Jun 2018 (Sat), 23 Jun 2018 (Sat)

09:30 - 17:30

VenueData Studio,Hong Kong Science Park

HKU SPACE, Admiralty Centre,18 Harcourt Raod, Hong Kong (Exit A, Admiralty MTR Station)(Computer Lab)

10:00 - 17:00

10:00 - 17:00

10:00 - 17:00 09:30 - 13:30

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16 May 2018 (Wed)

19:30 - 21:30

HKU SPACE, United Centre,95 Queenway,Hong Kong(Exit D, Admiralty MTR Station)

26 May 2018 (Sat)

10:00 - 17:00

HKU SPACE, Admiralty Centre,18 Harcourt Raod, Hong Kong(Exit A, Admiralty MTR Station)

Statement on Collection of Personal Data1. It is necessary for applicants to supply their personal data and to provide all the information requested in the application documents, as otherwise the College

may be unable to process and consider their applications.2. The personal data provided in this form will be used for processing your application for admission, and for registration, academic and administrative

communication, alumni management and contacts, research, statistical and marketing (including direct marketing) purposes. The data will be solely handled by Centennial College staff but may be transferred to an authorised third party providing services to the College in relation to the above purposes and prescribed purposes as allowed by the law from time to time.

3. When the processing and consideration of all the applications for a particular programme have been completed: (a) the application papers of unsuccessful candidates will be destroyed (if you have indicated to receive our promotional materials in Paragraph 5 then your contact details and related papers would

be handled by Centennial College staff or by staff of an authorised third party providing services to the College in relation to the stated purposes. In all such

4. The College will send urgent messages to students via Short Message Services (SMS) and supplement by other means such as email (if the need arises). It is therefore important that the mobile phone number and email address that the applicant provides are accurate. Any change should be reported to the College

Use of Personal Data Related to Direct Marketing5. From time to time, the College will send the latest updates and promotional materials to applicants/students and alumni on the availability of the programmes

and courses, seminars and events, discounts, offers and other services as well as the alumni events, privileges and offers, networking opportunities and fund-raising initiatives through various communication channels such as direct-mail, email and mobile phone, by using your personal data (including, but without

always have the right to make subsequent changes on your choice of receiving further marketing materials by sending a written unsubscribe request (by email to course@centennialcollege.hku.hk or by post) to the College at any time.

If you DO NOT WISH to receive our latest updates and promotional materials through the communication channels as stated above, including discounts and offers from time to time, please check this box.6. Under the provisions of the Personal Data (Privacy) Ordinance, applicants have the right to request the College to ascertain whether it holds your personal

data, to be given a copy, and to apply for correction of the data, if deemed incorrect. Applications for access to personal data should be made by using a special

Amendment” and submit it to Centennial College.7. For details on the College’s policy on personal data (privacy), please refer to the College Website.

Submission of Application8. Enrolment can be done by completing the application form and submitting relevant documents by email at course@centennialcollege.hku.hk. You can also mail to

the “Centennial College, School of Management, Room 310, 3 Wah Lam Path, Pokfulam Road, Hong Kong”, specifying “Programme/Course Application”. 9. Incomplete information or missing supporting documents will not be processed. Please make sure the following documents are attached before sending your

application:

(i) A completed application form; (ii) A photocopy of Hong Kong Identity Card; (iii) s working experience;

Payment Methods10 Only the following three payment methods will be accepted: A. Cheque / bank draft Crossed cheque / bank draft should be made payable to “CENTENNIAL COLLEGE”. Please write the applicant’s name, HKID card number and course

name on the back of the cheque / bank draft. B. Cash Deposit Cash deposit can be made via College’s bank account at HSBC. Account Name: CENTENNIAL COLLEGE Account No.: 848-202859-001 (Please email a copy of bank slip to course@centennialcollege.hku.hk with applicant’s full name and contact number.)

11.

12. application with late payment.

Fee Refund Policies13. Course fees paid are not refundable except as statutorily provided or under very exceptional circumstances.

Declaration1. I declare that all information given in this application form and the attached documents are, to the best of my knowledge, accurate and complete.2.

application.3. I consent that if registered, I will conform to the Statutes and Regulations of the University and the rules of the College.4. I have noted, understood and agree to the contents of the above notes, Statement on Collection of Personal Data and Centennial College policy on personal

data (privacy).

Signature: ______________________________________________ Date: __________________________________________________

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