June 2022

Application for Enrolment Form 報名表 SF26

For Office Use 由本學院填寫
Receipt No. 收據編號：
Admitted 取錄 Rejected 不取錄 Waiting List 後補名單
Please complete all relevant parts in BLOCK LETTERS and with BLACK PEN. Past students/Lifelong Learner Card holders without any change in personal
particulars are required to complete Part I only (for applying to a general/short course) and Part I & III (for applying to an award-bearing or professional
programme).HKID card or passport number is required for student record purposes. Applicants to award-bearing programmes are required to present their
HKID/passport for verification if applying in person or attach a copy of their HKID or passport if applying by post.
請 用 黑 色 原 子 筆 以 正 楷 填 寫 有 關 部 分。 舊 生 或 持 有 終 身 學 員 證 人 士， 如 沒 更 改 個 人 資 料， 只 需 填 寫 甲 部（ 申 請 短 期 及 興 趣 課 程 者 ）
或 甲 及 丙 部（ 申 請 學 歷 頒 授 及 專 業 課 程 者 ）。 申 請 人 必 須 填 寫 香 港 身 分 證 或 護 照 號 碼 以 作 學 員 記 錄 之 用。 學 歷 頒 授 及 專 業 課 程 的
申 請 人， 如 親 身 報 名， 須 出 示 身 分 證 ╱ 護 照 以 核 實 身 分； 如 以 郵 遞 方 式 報 名， 則 須 附 以 身 分 證 或 護 照 副 本 以 供 本 學 院 核 對 之 用。

Part I 甲部：Application Details 報讀課程資料 (Applicable to both NEW and PAST students 新生及舊生適用 )

Application Code 報名代碼 Programme/Course Title 課程名稱 Currency 貨幣 Fee 費用

2050 3 4 8 3NW Advanced Course in Catering the Diverse Learning Needs

of Youth in the VTC: Autism Spectrum Disorders

Title 稱謂 □ Mr 先生 □ Ms 女士
Student Name in English and Chinese (Name as appeared on H.K.I.D. card or passport) 英文及中文姓名 ( 香港身分證或護照上的姓名 )
Given Names Family Name
英文名字 英文姓氏
Name in Chinese Mobile Phone
中文姓名 流動電話
H.K.I.D./Passport No. HKU SPACE Student No. (If any)
香港身分證/護照號碼 學生證號碼（如有）
Holders of H.K.I.D card must fill in their H.K.I.D No. 香港身分證持有人必須填寫香港身分證號碼

Part II 乙部：Other Personal Particulars 其他個人資料

(Applicable only to NEW students or PAST students who have an update on their personal information 新生或需要更改個人資料之舊生適用 )

Email Address 電郵地址 Nationality 國籍

Date of Birth Day Month Year Permanent HK Resident
出生日期 日 月 年 香港永久性居民 □ Yes 是 □ No 否
(If ‘No’, see Notes to Non-local Applicants) ( 如填寫「否」，請細閱非本地申請人注意事項 )
Correspondence Address
通訊地址
Room/Flat 室 Floor 樓 Block, Building 座 , 大廈

Estate, Street/Road 屋苑 , 街道 District (e.g. Wan Chai, Kwun Tong, etc.) 地區（如灣仔、觀塘）

□ HK 香港 □ KLN 九龍 □ NT 新界
Emergency Contact Person 緊急聯絡人
In case of emergency, we may need to contact your family or friend. Please suggest. 如遇上緊急事故，我們或需聯絡你的家人或朋友，請提供聯絡人資料。

Contact Person 聯絡人 Phone 電話

Please continue to next page

請繼續填寫下頁
For applicants not holding
a Lifelong Learner Card
Please complete this part 請填妥本欄
適用於未持有終身學員證之申請人

Please affix a recent colour photo

(in plain background) of Name 姓名
the applicant for producing
the Lifelong Learner Card. Address 地址
請貼上申請人之彩色近照一張
( 照片背景必須無任何裝飾 )
以作印製終身學員證用途

45mm x 55mm

Name 姓名
Contact No. 聯絡電話
Programme/Course No. P.1
課程編號
Part III 丙部：Other Relevant Information 其他相關資料
(Applicable to NEW students or PAST students who have an update 新生或需更新其他相關資料之舊生適用 )

HKU SPACE Alumni

All new enrolled students in the School will automatically receive a lifelong learner card which serves as the student card. It also confers eligibility to become an alumnus of
HKU SPACE. If you DO NOT WISH to be an alumnus, please check this box. □
本學院的註冊學生將自動獲發終身學員證為學生證。持證人可成為香港大學專業進修學院校友。如 閣下不想成為校友，請在方格內填上剔號。 □

Equal Opportunities for Learning at HKU SPACE

The School supports equal opportunity and strongly opposes discrimination / harassment. The document, "Studying in HKU SPACE" is available from the Prospectus/Website
and sets out such policy more fully.
It is the School policy to offer equal opportunities to all applicants with or without disabilities. To enable us to meet the needs of all students, you are invited to indicate on this
form whether you require any special assistance. If you do need such assistance, the School may approach you subsequently to obtain further details so as to facilitate our
planning and assess how best we can help you.
學院支持平等機會並强烈反對歧視 / 騷擾行為。在課程手冊 / 網頁刊載的【學在 HKU SPACE】進一步闡述有關政策。
學院的方針就是為所有人士提供平等的學習機會。為了配合學生的需要，請在此報名表上說明你是否需要特殊的幫助。如有需要，學院將聯絡 閣下，以獲取更多相關資料及提供
更完善的服務。
Special assistance required 是否需要特殊的幫助 Yes 是 □ (if you check yes, you agree to give us further information on No 否 □
your special needs and consent to our further processing of your data
如選擇需要，閣下 同意提供進一步詳情及同意學院處理相關資料 )

Statement on Collection of Personal Data

1. It is necessary for applicants to supply their personal data and to provide all the information requested in the application documents, as otherwise the School may be
unable to process and consider their applications.
2. The personal data provided in this form will be used for processing your application for admission, and for registration, academic and administrative communication, alumni
management and contacts, research, statistical and marketing (including direct marketing) purposes. The data will be solely handled by HKU SPACE staff but may be
transferred to an authorised third party providing services to the School in relation to the above purposes and prescribed purposes as allowed by the law from time to time.
3. When the processing and consideration of all the applications for a particular programme have been completed: (a) the application papers of unsuccessful candidates will
be destroyed (if you have indicated to receive our promotional materials in Paragraph 6 then your contact details and opt-in consent would be retained for such purposes);
and (b) the application papers of successful candidates will serve as part of the applicant’s official student records and will be handled by HKU SPACE staff or by staff of
an authorised third party providing services to the School in relation to the stated purposes. In all such circumstances, please be assured that any personal information
you supply will be kept strictly confidential. Personal data collected arising from any payment for this application may be retained as statutorily required and for processing
refund, if necessary.
4. Upon enrolment, applicants will be required to submit a recent colour photo for student identification purpose.
5. The School will send urgent messages to students via Short Message Services (SMS) and supplement by other means such as email (if the need arises). It is therefore
important that the mobile phone number and email address that the applicant provides are accurate. Any change should be reported to the School immediately. Those who
have genuine difficulty in receiving urgent messages via SMS should contact the programme teams for separate arrangements.

Use of Personal Data related to Direct Marketing

6. From time to time, the School will send the latest updates and promotional materials to applicants/students and alumni on the availability of the programmes and courses.
This will also include seminars and events, discounts and offers, clinics and other services as well as the alumni events, privileges and offers, networking opportunities
and fund-raising initiatives. Occasionally information from our parent University and fellow HKU subsidiaries may also be sent. Various communication channels will be
employed such as direct-mail, email, mobile phone and other forms of social media, by using your personal data (including, but without limitation to, your name, contact
details and other information collected in your profile such as the programme(s) you enrolled, your graduation year etc). You always have the right to make subsequent
changes on your choice of receiving further marketing materials by sending a written unsubscribe request (by email or by post) to the School at any time.
If you DO NOT WISH to receive our latest updates and promotional materials through the communication channels as stated above, including discounts and
offers from time to time, please check this box. □
7. Under the provisions of the Personal Data (Privacy) Ordinance, applicants have the right to request the School to ascertain whether it holds your personal data, to be
given a copy, and to apply for correction of the data, if deemed incorrect. Applications for access to personal data should be made by using a special request form and
on payment of a fee. Such applications for access to information should be addressed to the Data Protection Officer, HKU SPACE. For general requests of personal data
amendment, please fill out the “Application Form for Personal Data Amendment” and submit it to HKU SPACE.
8. For details on the School’s policy on personal data (privacy), please refer to the School Prospectus or Website (http://hkuspace.hku.hk/policy-statement/privacy-policy).
9. HKU SPACE, being part of the University of Hong Kong, the Personal Information Collection Statement and the Supplement in relation to the General Data Protection
Regulation of the University also apply where applicable and can be accessed from http://www.aal.hku.hk/admissions/documents/pics.pdf and https://admissions.hku.hk/
tpg/sites/default/files/GDPRPrivacyNotice_ApplicantsandStudents.pdf. Being in partnership with other overseas Universities, it also endeavours to comply to their laws and
regulations as far as practicable. However, the School is obliged to maintain part of the students’ records in perpetuity for reasons stated in this PIC.
1. 申請人必須提供其個人資料及課程申請所需資料，否則本學院將不能有效處理其申請。
2. 在法律許可情況下，個人資料將會作入學申請、註冊、有關學術及行政通訊、校友事務及聯絡、研究、統計、市場分析及推廣（包括直接銷售）等用途。只有香港大學專業進
修學院職員才能處理有關資料，但亦可能會轉移到為學院提供有關服務的委託人處理。
3. 完成報名程序及課程註冊後，申請人如不獲取錄，其個人資料將會被銷毀（如申請人於以下第 6 項表明願意接收學院的推廣訊息，申請人的聯絡資料及同意接收學院推廣訊息
的記錄將保留作此等用途），獲取錄者的個人資料將會被留作學生記錄，只有香港大學專業進修學院職員或為學院提供有關服務的委託人才能處理有關檔案，而 閣下提供的
所有個人資料將絕對保密。報名付款時所收集的個人資料，則循法例規定留作相關用途，以及退款處理之用 ( 如需要 )。
4. 如獲取錄，申請人需呈交彩色近照一張以作學生證明之用。
5. 在緊急情況下，學院將向學生發放電話短訊，或在有需要時附以其他方式，如電子郵件，以作通知。請準確填寫有關資料以便聯絡。如有任何更改，請儘快向學院提出更新。
如 閣下對接收電話短訊通知遇有困難，請聯絡課程組，以便作適當安排。

6. 申請人提供的個人資料（包括姓名、聯絡方法及其他資料如曾報讀的課程、畢業年份等）將用作與學院溝通渠道，學院將透過信件、電子郵件、流動電話和其他社交媒體等為
申請人、學員和校友送上學院的最新課程資料及推廣訊息，這些資訊亦將包括學院講座及活動、折扣優惠、診所服務、校友會活動、校友會會員尊享優惠、校友聯誼及籌款活
動等，當中亦可能包括香港大學或其附屬機構的不定期資訊。 閣下可隨時以書面或電郵方式向學院申明是否願意繼續接收有關資訊。
如不欲收到任何透過上述渠道發出的資訊，包括折扣優惠，請在方格內填上剔號。□
7. 根據個人資料（私隱）條例，申請人有權知悉學院有否保留其個人資料，同時亦可查閱、索取及更改其個人資料。申請人如欲查閱其個人資料，請填妥指定表格並交回本學院
個人資料私隱主任。本學院將會酌情收取行政費用。如欲更改一般個人資料，請填妥「申請更改個人資料表格」並交回本學院。
8. 如欲了解本學院私隱政策的詳情，請參閱本學院的課程手冊或網頁 (http://hkuspace.hku.hk/cht/policy-statement/privacy-policy)。
9. 本學院作為香港大學的一部分，大學的收集個人資料聲明及有關於通用數據保障條例之附加內容亦適用於本學院，詳情請參閱 http://www.aal.hku.hk/admissions/documents/
pics.pdf 及 https://admissions.hku.hk/tpg/sites/default/files/GDPRPrivacyNotice_ApplicantsandStudents.pdf ( 只提供英文版本 ) 。 學院亦與海外院校合作，在可行範圍內當
遵從當地法律及條例處理相關個人資料，但學院仍需依循本院收集個人資料目的，保留某些項目作為永久學生記錄。
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General Notes to Applicants

1. Enrolment can be done in person at any of the School's Enrolment Centres by completing this application form and submitting it with the appropriate fee and relevant
documents. You can also mail to the “HKU School of Professional and Continuing Education, Room 304, 3/F, T. T. Tsui Building, The University of Hong Kong, Pokfulam
Road, Hong Kong”, specifying “Programme/Course Application”.
2. Fees paid by crossed cheque or bank draft should be made payable to “HKU SPACE”.
3. If the programme/course is starting within five working days, application by post is not recommended to avoid any delays. Applicants are advised to enrol in person at HKU
SPACE Enrolment Centres and avoid making cheque payment under this circumstance.
4. If admission is on a first come, first served basis and if you do not hear from us before the course starts, you may assume that your application has been accepted, and
should attend the course as scheduled.
5. If admission is by selection, the official receipt is not a guarantee that your application has been accepted. We will inform you of the result as soon as possible after the
closing date for application. Unsuccessful applicants will be given a refund of programme/course fee if already paid.
6. If you are applying to / have enrolled for more than one programme/course with HKU SPACE, please check to ensure that there are no scheduling conflicts before
submitting your application form.
7. If you do not know the teaching venue within 3 days of the starting date of the course, please check with the relevant programme team.
8. Course fees paid are not refundable except as statutorily provided or under very exceptional circumstances (e.g. course cancellation due to insufficient enrolment).
9. Please refer to the HKU SPACE Prospectus and the official website for full details of enrolment procedures for HKU SPACE Programmes.
1. 報讀課程，請親往學院各報名中心，呈交填妥的報名表格、學費和所需的證明文件，或以郵遞方式，寄「香港薄扶林道香港大學徐展堂樓 3 樓 304 室香港大學專業進修學院」
並註明「報讀課程」。
2. 如以劃線支票或銀行本票付款，抬頭請書名「香港大學專業進修學院」。
3. 如報讀課程將在五個工作天內開課，為免郵遞延誤報名程序，建議申請人親身到學院報名中心報名，並避免使用支票付款。
4. 以「先到先得」方式獲取錄的學生，可自行依照課程手冊或學院網頁所列的時間到有關地點上課。除特殊情況外，學院將不作另行通告。
5. 如須甄選入學，則正式收據並不可作為 閣下已獲取錄的證明。學院將在截止報名日期後儘快通知申請者是否獲得取錄。落選的申請人將獲退還已繳交的學費。
6. 如打算/已經在學院報讀多於一個課程或以上，請細閱各個課程的上課時間地點，以免上課時間重疊。
7. 如在開課前三天仍未知悉上課地點，請與課程組聯絡。
8. 除特殊情況（例如課程因報名人數不足而被取消）及法例規定外，一切已繳費用，概不退還。
9. 有關香港大學專業進修學院的入學程序及詳情，請參閱香港大學專業進修學院的課程手冊及官方網頁。

HKU SPACE Vaccine Pass

To minimize the risk of COVID-19 transmission in learning centres and offices and to keep the HKU SPACE community safe, access to the HKU campus or HKU SPACE
premises will need to comply with the tightened measures in line with the University. Please refer to details on implementation on our Website/Learner Portal and please do
note that there may be further updates from time to time to take account of possible changes in the Government guidelines and University arrangements.
為防範及控制 2019 冠狀病毒病的傳播以及保障學院學員及員工的安全，進入香港大學校園或香港大學專業進修學院處所，皆須遵從與香港大學一致的收緊防疫措施，請密切
留意學院網頁及學員網站公佈的具體細節，並須留意有關運作可能不時跟隨政府及大學的安排而作調整。

Class arrangement during COVID-19

The COVID-19 situation may still be fluid and constantly affect class arrangements in the coming months. The health and safety of our students will always be our top
priority. To ensure that students' academic progress is not affected, the School may substitute face-to-face classes with online teaching if necessary in the event that face-
to-face classes cannot be held. Our respective Programme Teams will contact the students concerned with details of such arrangements as necessary.
在新型冠狀病毒疫情不穩定的狀態下，未來數月可能持續影響我們的課堂安排。學院一向以學員的健康及個人安全為首要考慮，為確保學生的學習進度不受影響，學院有可能
需要按有關指引將面授課堂改為網上授課。如出現此等情況，課程組別同事將會儘快聯絡學員有關安排的詳情。

Notes to Non-local Applicants

To study in Hong Kong, all non-local applicants are required to obtain a student visa issued by the Immigration Department of the HKSAR Government, except for those
admitted to Hong Kong as dependants, who do not need prior approval before taking up full-time and part-time studies. Non-local applicants issued with a valid employment
visa also do not need prior approval to pursue part-time studies. It is the responsibility of individual applicants to make appropriate visa arrangements. Admission to a HKU
SPACE academic programme/course does not guarantee the issue of a student visa. Applicants may wish to note that part-time courses are not considered by the Immigration
Department for visa purposes except for self-financed, part-time locally accredited taught postgraduate programmes awarded within the HKU system through HKU SPACE.
非本地申請人必須持有由香港特區政府入境事務處所簽發的學生簽證方可入讀本院，申請人入學前須辦妥有關手續。惟以受養人士身分獲批准來港者，毋須經事先批准，可修讀全
日制及兼讀制課程。而獲發有效工作簽證之非本地申請人毋須事前批准，亦可修讀兼讀制課程。獲香港大學專業進修學院課程取錄並不代表能成功獲發有關學生簽證。除自資並經
本地評審，而有關學銜按香港大學體制，經香港大學專業進修學院頒發的兼讀制深造修讀課程外，兼讀制課程暫不在入境處考慮批發簽證之列。

Declaration

1. I declare that all information given in this application form and the attached documents are, to the best of my knowledge, accurate and complete.
2. I authorise the School to obtain, and the relevant authorities to release, any information about my qualifications and/or employment as required for my application.
3. I consent that if registered, I will conform to the Statutes and Regulations of the University and the rules of the School.
4. I have noted, understood and agree to the contents of the above notes, Statement on Collection of Personal Data and HKU SPACE policy on personal data (privacy).
1. 本人聲明本申請表及隨附文件所載一切資料，依本人所知均屬正確，並無遺漏。
2. 本人授權香港大學專業進修學院向相關機構查閱有關本人申請課程所列出的學歷及專業資格。
3. 本人同意如本人註冊入學，當遵守大學及學院的規例。
4. 本人已細閱、明白並同意以上注意事項、收集個人資料聲明及有關香港大學專業進修學院在處理個人資料（私隱）的守則。

Signature 簽署 Date 日期

HKU SPACE is a non-profit making University company limited by guarantee 香港大學專業進修學院乃非牟利擔保有限公司

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