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Net's Be Wise Program Application Form 數碼NET人課程報名表
Please complete this form and submit to JAHK.
請填妥以下表格,並交回JAHK。
School Information 學校資料
English Name 英文名稱 *
Your answer
Chinese Name 中文名稱 *
Your answer
English Address 英文地址 *
Street No. & Street
Your answer
*
District
Your answer
*
HK/KLN/NT
Chinese Address 中文地址 *
Your answer
School Tel 學校電話 *
Your answer
School Fax 傳真號碼 *
Your answer
School Website 學校網址
Your answer
Head of School 校長
English Name 英文姓名
Sal 稱呼
*
Surname 姓
Your answer
First Name 名
Your answer
Chinese Name 中文姓名
Your answer
Email Address 電郵地址
Your answer
Office Tel. No. 辦公室電話
Your answer
Link Teacher 負責老師
English Name 英文姓名 *
Sal 稱呼
*
Surname 姓
Your answer
*
First Name 名
Your answer
Chinese Name 中文姓名
Your answer
Position 職位 *
Your answer
Office Tel No. 辦公室電話 *
Your answer
Mobile No. 手提電話 *
Your answer
Email Address 電郵地址 *
Your answer
Expected Number of Participating Students 預算參與學生人數
*
Total Expected Number of Students 預算參與學生總人數
Your answer
Expected Number of P3 Students 預算小三學生人數
Your answer
Expected Number of P4 Students 預算小四學生人數
Your answer
Expected Number of P5 Students 預算小五學生人數
Your answer
Expected Number of P6 Students 預算小六學生人數
Your answer
Language of Instruction 授課語言
*
Program Date 活動日期
Program Dates 活動日期 *
Preferred Program Starting Date 預算課程開始日期 *
MM
/
DD
/
YYYY
Preferred Program End Date 預算課程結束日期 *
MM
/
DD
/
YYYY
Declaration 聲明
I declare that the information given in this application is true and accurate, and confirm that this application has been endorsed and supported by the school. I hereby authorise Junior Achievement Hong Kong (JA) to contact relevant parties and verify information given in this application form.

本人聲明此申請表格內之資料屬實及準確,並確定此申請已得到校方認可及支持。本人謹此授權青年成就香港部與有關人士聯絡,核實申請表格內之資料。

*
Name 姓名 *
Your answer
Position 職位 *
Your answer
Date 日期 *
MM
/
DD
/
YYYY
Please print a copy of this completed form for your record before submitting this form. 遞交前,請先列印已填妥的申請表以作記錄。
How do you know about this program? 從哪渠道得知此課程?
Your answer
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