Bai Xian Asia Institute Asian Future Leaders Scholarship Program (AFLSP) Application for 2022 Cohort Important Notes: • You are required to submit a short video (up to 3 minutes in length) together with your application. More details can be found at the end of this application form. • You may be invited for an interview with the BXAI Selection Panel. • Please save this application form as pdf format after you have completed the form. Personal Particulars Name (as per passport) Surname: Given name: Gender: Date of birth (DD/MM/YYYY): Nationality and Citizenship (list all if more than one): Ethnic Origin: Current Country of Residence: Email: Contact Number (area code + local phone number): Current Mailing Address (apt #, street name, city, zip code, country): Permanent Mailing Address (apt #, street name, city, zip code, country): Which BXAI’s Partner University are you applying to: Application Number: Degree Program (specific field) E.g. Bachelor of Science (Biomedical Sciences): Course name (if any): Bai Xian Asia Institute 百 賢 亞 洲 研 究 院 +852 3958 4788 [email protected]www.bxai.org 10/F, Novel Industrial Building, 850-870 Lai Chi Kok Road, Cheung Sha Wan, Kowloon, Hong Kong 香 港 九 龍 長 沙 灣 荔 枝 角 道 八 五 零 至 八 七 零 號 永 新 工 業 大 廈 十 樓
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Bai Xian Asia Institute Asian Future Leaders Scholarship Program (AFLSP)
Application for 2022 Cohort
Important Notes:
• You are required to submit a short video (up to 3 minutes in length) together with your
application. More details can be found at the end of this application form.
• You may be invited for an interview with the BXAI Selection Panel.
• Please save this application form as pdf format after you have completed the form.
Personal Particulars Name (as per passport)
Surname:
Given name:
Gender:
Date of birth (DD/MM/YYYY):
Nationality and Citizenship (list all if more than one):
Ethnic Origin:
Current Country of Residence:
Email:
Contact Number (area code + local phone
number):
Current Mailing Address (apt #, street name, city, zip code, country):
Permanent Mailing Address (apt #, street name, city, zip code, country):
Which BXAI’s Partner University are you applying to:
Application Number:
Degree Program (specific field) E.g. Bachelor of Science (Biomedical Sciences):
Course name (if any):
Bai Xian Asia Institute 百 賢 亞 洲 研 究 院 +852 3958 4788 [email protected] www.bxai.org 10/F, Novel Industrial Building, 850-870 Lai Chi Kok Road, Cheung Sha Wan, Kowloon, Hong Kong 香 港 九 龍 長 沙 灣 荔 枝 角 道 八 五 零 至 八 七 零 號 永 新 工 業 大 廈 十 樓
This may involve the transfer of your personal data outside of Hong Kong to the People’s Republic of
China, Japan, Korea and Taiwan where there may not be in place data protection laws which are
substantially similar to, or serve the same purposes as, the PDPO. That means your personal data may
not be protected to the same or similar level in Hong Kong.
3. Any personal data collected will be kept strictly confidential and handled in accordance with
applicable laws. Unless permitted or required by law, the Institute will not disclose your personal data
to any other third parties without your prior consent. Bai Xian Asia Institute’s website uses SSL protocol
to encrypt data during network transmission to protect your personal data. All personal data you
provide to the Institute via our website are secured, and access to them is restricted to authorized
personnel only.
4. The Institute may invite you to subscribe to updates to certain information from time to time. If you
do not wish to receive the information mentioned in any means, please make your request along with
your name, contact number and email address be submitted to us either by email or phone. If you do
not wish to receive these updates through email, you may click the unsubscribe link as shown in our
electronic promotional materials.
5. BXAI reserves the sole right to amend the terms and conditions of the Privacy Policy Statement and
Personal Information Collection Statement and any other policy or arrangement stated herein at any
time and all handling of personal data will be governed by the most recent version of the Privacy Policy
Statement and Personal Information Collection Statement, available on our website (www.bxai.org). If
there is any inconsistency or conflict between the English and Chinese versions, the English version
shall prevail.
If you have any questions or comments please contact us at [email protected].
☐ I agree to the collection, use and transfer of my personal data within or outside of Hong Kong as
stated in the "Privacy Policy Statement and Personal Information Collection Statement."
Consent of Applicant to Indirect Collection of Information ☐ I certify that the information provided in this application is true and I have a continuing
obligation to advise the Institute if there is a change in circumstances.
☐ I hereby authorize the Institute and any relevant Participating University to exchange information
related to my application, including but not limited to my transcript and personal particulars, for the
purpose of assessing my application.
Bai Xian Asia Institute 百 賢 亞 洲 研 究 院 +852 3958 4788 [email protected] www.bxai.org 10/F, Novel Industrial Building, 850-870 Lai Chi Kok Road, Cheung Sha Wan, Kowloon, Hong Kong 香 港 九 龍 長 沙 灣 荔 枝 角 道 八 五 零 至 八 七 零 號 永 新 工 業 大 廈 十 樓