Please read the Neuroacademi Scholarship leaflet carefully before filling in the application
請在遞交申請表前先參閱思捷堂獎學金申請細則:

Neuroacademi Early Elite Education Scholarship
思捷堂優質幼教獎學金

Please tick the box if you:

請選出你是那一項

	Category A 第一類		Category B 第二類
	Interested in learning more about Neuroacademi materials and the value to early education		I have already bought Neuroacademi materials for my child(ren) Contract No:
	預算購買		擁有
	I want to become a Neuroacademi Education Consultant. Please contact me with further information		I am a Neuroacademi Education Consultant. Reference No:
	希望成為		思捷堂的教育顧問

PERSONAL DETAILS OF APPLICANT 申請人個人資料

Applicant's Full Name in English 申請人英文姓名

Surname 姓: First 名: Middle 別名:

Chinese Name 中文姓名:

HKID/Passport NO.
香港身分証/護照號碼:

Gender 性別:

男女

Place of Birth 出生地點:

Citizenship國籍:

Name of Child 子女姓名

English 英文:

Chinese 中文:

Age of the Child 子女年齡:

Your child is currently studying at

現就讀之學校名稱:

Grade 班級:

You wish to use the scholarship funds for

Your kids status is

	Accepted and Enrolled for 2009/10 academic year 已被接受在2009/10學年入讀
	Applying/Will submit application for 2009/10 academic year 已經/將會申請在2009/10學年入讀

你期望為子女挑選的學校:

其它 Other:

I certify that the information given on this application is true. I understand that I may be disqualified if I submit false information. I authorize my application materials and information be used in whatever manner as deemed necessary by Neuroacademi for the purpose of assessment of the application. I agree that I will join Neuroacademi’s promotion events twice a year and agree that they may use photos approved by me for promotional purpose if my application is successful. By signing this document, I confirm that I have read and agree to the terms and conditions of application
本人證實此申請表內所提供的資料及文件全屬真確,並明白所有有關情況的資料如不符合獎學金所列之指引,將可能導致申請人已獲批准了的獎學金資格被取消。本人同意思捷堂使用本申請內所提供的資料。如本人獲得此獎學金本人同意參與每年兩次思捷堂之推廣活動並同意使用本人之個人資料及相片作推廣之用。以下簽署代表本人已閱讀及接受以上條款。