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SH Workshop@School (知安識健體驗坊) Application Form 2018/19
Please complete this form and submit to JA HK.
請填妥以下表格,並交回JA HK。
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
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 student (student number need to be in between 90 and 120) 預算參與學生人數(需介乎90-120人之間)
Form 級別
Your answer
Number of Student 學生人數
Your answer
Program Schedule 活動日期及時間
Preferred Program Date 活動舉行日期 *
First Choice 第一選擇
MM
/
DD
/
YYYY
Second Choice 第二選擇
MM
/
DD
/
YYYY
Third Choice 第三選擇
MM
/
DD
/
YYYY
Preferred Program Time 活動時間 (2.5hrs 2.5小時)
First Choice 第一選擇
Preferred Program Time 活動時間 (2.5hrs 2.5小時)
Second Choice 第二選擇
Preferred Program Time 活動時間 (2.5hrs 2.5小時)
Third Choice 第三選擇
Remarks 備註
Your answer
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 JA HK 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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