傑出非華裔學生獎勵計劃 2025 提名表格 Nomination Form for Outstanding Ethnic Minority Student Award Scheme 2025
請填妥本表格，並於二零二五年二月二十八日 (下午五時正) 或之前遞交; Please complete and submit this form on or before 28 February 2025 (5 p.m.)
A. 組別 School Category （請剔選 Please tick as appropriate）
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小學 小一至小三 Primary 1-3
小學 小四至小六 Primary 4-6
中學 中一至中三 Secondary 1-3
中學 中四至中六 Secondary 4-6
B. 學校資料 School Information
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C. 學生資料 Student’s Information
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D. 提名內容 Content for Nomination
請參考提名指引中的評分準則，以中文或英文簡述此學生在過往一年於各項的表現。Please briefly describe in English or Chinese the student’s performances in various aspects in the past year. Kindly refer to the assessment criteria in the ‘Nomination Guidelines’ for scoring proportions for each School Category.
(D1) Academic Performances 學業成績表現 (32%) (Please list the most recent examination result. 請填寫最近一次考試成績。 )
Rows
Position
in Form
排名/人數(全級)
Marks
成績/總分
Grade
等級
Month/Year
(Student Report)
月份/年份
(成績表)
Award
Received
(if applicable)
曾獲獎項(如適用)
Remarks
(Academic curriculum 課程)
(if
applicable) (如適用)
Chinese Language 中國語文
English Language 英國語文
Mathematics 數學
Other Subjects (Please specify : ______________ ) 其他學科,請註明 :
Please provide a copy of documentary proof for each item. 請上載最近年度的成績表副本。
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D2) Leadership Ability 領導才能 (8%) (Please list service participated in / related awards received in the past 3 years. Maximum 4 items. 請填寫最多四項於最近三年所服務的職位或其獲得獎項。)
Rows
Month/Year 月份/年份
Service Units / Award Organiser 服務/頒獎機構
Position 職位
Duties 職責
Award Received (if applicable) 曾獲獎項(如適用)
1
2
3
4
D3)Student Conduct校內操行 (5%) (Please list the most recent conduct performance in the student report. 請填寫最近一次成績表上的品行評估。
Rows
Month/Year (Student Report) 月份/年份 (成績表)
Grade 等級
Title of Award Received (if applicable) 曾獲獎項或稱許 (如適用)
List here
Please provide a copy of documentary proof for each item. 請上載最近年度的成績表副本。
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D4) Academic Awards/Scholarships 學術獎項/獎學金 (10%) (Please list awards received in the past 3 years. Maximum 5 items. 請填寫最多五項於最近三年所獲得的學術獎項或者獎學金。)
Rows
Month/ Year of Award 月份/年份
Title of Award Received 獎項/獎學金名稱
Award Title 獎項銜頭
Award Organiser/Scholarship 主辦機構
1
2
3
4
5
D5) Non-Academic Awards/Scholarships 非學術獎項/獎學金 (10%) (Please list non-academic related awards, such as debate, speech, music, sports, dance,etc. received in the past 3 years. Maximum 5 items. 請填寫最多五項於最近三年所獲得的非學術獎項或者獎學金，例如辯論、朗誦、音樂、體育、舞蹈等。)
Rows
Month/ Year of Award 月份/年份
Title of Award Received 獎項/獎學金名稱
Award Title 獎項銜頭
Award Organiser/Scholarship 主辦機構
1
2
3
4
5
D6) Voluntary/Community Service Experiences 社會服務經驗 (10%) (Please list services provided to organizations outside of the school in the recent 3 years. Maximum 5 items. 請填寫最多五項於最近三年所參加的社會服務，服務對象必須為校外人士。e.g. Red Cross, NGO, etc. 例如紅十字會、社福機構等; )
Rows
Year
of Award
月份/年份
Organiser
機構名稱
Position 擔任職位
Nature
of Service 服務內容
Total
No. of Service Hours 合共服務時數
1
2
3
4
5
Please provide a copy of documentary proof for each item. 請上載相關證明文件。
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D7) Participation in Extra-Curricular Activities 校內／校外的活動參與 (20%) (Other than community service listed in D6, please list maximum 10 items of extra-curricular activities rendered and qualifications obtained in the past 3 years. 請填寫最多十項於最近三年在校內或校外所參與的課外活動及資格，不包括已在D6闡述過的社會服務活動。)
Rows
Month/Year
月份/年份
SName of Organization 服務/活動機構
Position 職位
Activities Participated 活動參與內容
Qualifications Received (if applicable) 曾獲資格(如適用)
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2
3
4
5
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9
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D8) Reasons for the nomination 提名原因 (5%) (請簡述提名此學生角逐傑出非華裔學生獎勵計劃的原因，例如學生如何在遇到挑戰或挫折時，積極克服困難，表現出堅毅的精神，並不限於學術表現。Briefly describe why you would like to nominate this student for the award, e.g., how the student has been persistent and positive in overcoming challenges despite of difficulties etc. It is not limited to school academic performances.)
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聯絡老師簽署：Signature of the Teacher in Charge:
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