Application Form - The Hong Kong Institute of Education

APPLICATION FORM FOR ADMISSION TO
POSTGRADUATE DIPLOMA IN EDUCATION PROGRAMMES 2004 ENTRY
CHOICE OF PROGRAMME AND SUBJECT
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Application No.
First Preference
Second Preference (optional)
Programme Code
Programme Title
Subject Code
Teaching Subject Study 1 [TSS1] / Major Subject Studies [MSS]
Teaching Subject Study 2 [TSS2] (For A1P014 / C2P035 only)
Notes: 1. Please refer to the “Application Guide” for the programme code, programme title and subject code.
2. Each applicant is allowed to select a maximum of TWO different programmes in the order of preference. If you are applying for two programmes, please photocopy one
more set of completed application form and academic documents for submission. This allows the Institute to process both of your applications at the same time.
3. No change of programme or subject is allowed once the application form is submitted.
PERSONAL PARTICULARS
Please enter information in this section as printed on your HKID card/passport. (Please refer to Personal Particulars Section in the “Application Guide”)
Full Name in English
Surname
Other Names
Name in Chinese Local / Non-local Applicant Sex
L = Local
M = Male
N = Non-local
F = Female
Chinese Name in Code
Date of Birth
H.K. Identity Card No.
( )
Passport No
CORRESPONDENCE INFORMATION
Correspondence Address (Please use BLOCK LETTERS in English.)
/ /
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Day Month Year
District Code
(Please refer to the list of district codes in the “Application Guide”.)
Day Contact Telephone No. Ext. (if applicable) Evening Contact Telephone No. Ext. (if applicable)
Mobile Phone / Pager No. A/C (if applicable) Fax No.
E-mail Address:
INFORMATION ON DISABILITY
Applicants with a disability please put a “Y” into the box below and state the nature and degree of disability. Otherwise, please put an “N”.
All applicants will be considered on the same basis. The collection of information about the nature and degree of any disabilities will be used by the Institute
to assess the provision of facilities to benefit students from the studies.
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ACADEMIC QUALIFICATIONS
1. Have you obtained a bachelor’s degree? Please enter “Y” for Yes or “N” for No.
( Note: If you are a final-year university student, please also enter “Y”. )
Please attach copies of certificates and transcripts with explanatory notes.
a. Name and Country of Institution granting the above qualification
Country
b. Title of award
c. Major discipline
d. Minor discipline
e. Classification of award
f. Duration of the programme
Years
g. Month and year of graduation
Month
Year
2. Please use the following codes to indicate the additional qualifications obtained other than the bachelor's degree (if applicable):
M
B
C
D
E
O
Master’s Degree or above
Higher Diploma
Diploma
Higher Certificate
Certificate
Others
a. Name and Country of Institution granting the above qualification
Country
b. Title of award
c. Major discipline
d. Minor discipline
e. Classification of award
f. Duration of the programme
Years
g. Month and year of graduation
Month
Year
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PUBLIC EXAMINATION RESULTS
Please attach copies of certificates.
Please “ ✓ ” the appropriate box(es).
1. Language Examinations Results
Public Examination Language Subjects Year of Attempt Grade / Score
HKALE Chinese Language & Culture
(A-Level / AS-Level) Chinese Language & Literature
Other public examinations
(e.g. GCE, IELTS, TOEFL), if applicable:
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Chinese Literature
English Literature
Use of English
2. Language Proficiency Assessment for Teachers
LPAT (English Language)
Paper 1 Reading
Year of Grade /
Attempt Score
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Year of Grade /
Attempt Score
Paper 2
Writing
Paper 3
Listening
Paper 4
Speaking
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Paper 5
Classroom Language Assessment
3. For applicants applying for the following subjects as Teaching Subject Study 1 & 2 [TSS1 & TSS2] in A1P014 or C2P035
Public Examination
Teaching Subject Study 1 / 2 Subject Taken HKCEE HKALE (A-Level / AS-Level)
(Year of Attempt & Grade)
(Year of Attempt & Grade)
• Putonghua Putonghua
Public Examination
Teaching Subject Study 2 Subject Taken HKCEE HKALE (A-Level / AS-Level)
(Year of Attempt & Grade)
(Year of Attempt & Grade)
• Art Art
Others (please specify)
Others (please specify)
• General Studies / Biology
• Civic Education Chemistry
Chinses History
Chinese Literature
Economics
Geography
History
Physics
• Information Technology / Computer Studies
• Mathematics Mathematics
• Music Music
• Physical Education Physical Education
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INFORMATION ON CURRENT TEACHING APPOINTMENT
Applicants applying for admission to C2P035 or C2P037 must fill in this section.
1. Are you a full-time secondary/primary school teacher? If yes, please enter “S” for “secondary teacher”; “P” for “primary teacher” or “N” for “No”.
If yes, please provide the following information:
a. Name and Address of Current School (Use BLOCK LETTERS in English.)
School Name:
School Address:
For Office Use
School District Code
(Please refer to the list of district codes in the “Application Guide”.)
b. Please use the following codes to indicate the nature of your school:
i) A = AM
P = PM
W = Whole Day
ii) A = Aided School
D = Direct Subsidy School
G = Government School
P = Private School
S = Special School
c. Total no. of periods per week / cycle currently taught.
d. Please indicate the major teaching subject(s), periods per week / cycle and level currently taught.
Major Teaching Subject(s) Periods Per Week / Cycle Level Currently Taught*
Normal Class (NC)
Resource Class (RC)
* Please use the following codes to indicate the level currently taught.
J = P1 – P3, S1 – S3
S = P4 – P6, S4 – S6
B = P1 – P6, S1 – S6
2. Please indicate the total number of years and months of full-time secondary / primary school teaching experience
(including current school): (count up to 1 September 2004)
Year
Month
Please provide information in chronological order.
OTHER FULL-TIME TEACHING EXPERIENCE
Date (Month / Year)
Rank
Name of School
From To (e.g. GM)
Teaching Subjects
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Please provide information in chronological order.
OTHER FULL-TIME WORKING EXPERIENCE
Date (Month / Year)
From
To
Name of Organisation Position Responsibilities
CONCURRENT POSTGRADUATE STUDIES
Please give details of other postgraduate programme(s) in which you are enrolled at the time of making this application. Distance learning programme(s)
should also be included.
Name of Institution
Title of Programme
Study Mode
(FT/PT/DL)
Qualification and
Expected date of completion
ADDITIONAL RELEVANT INFORMATION
Please provide any information which you think is relevant to the assessment of your application.
DECLARATION BY APPLICANT
1. I declare that all the information given above in support of my application is to the best of my knowledge accurate and complete. I understand that any
omission or misrepresentation of information will lead to disqualification of my application for admission and subsequent enrollment in the Institute.
2. I authorize The Hong Kong Institute of Education to
(a) use my data as a basis for various types of processing in relation to my application;
(b) have my personal data transferred to the student record system which may be used for statistical and research purposes by the Institute upon my
admission to the programme; and
(c) use my data to carry out checks on multiple registrations at this or other local / overseas institutions.
Signature of Applicant:
Date:
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RECOMMENDATIONS (To be completed by the current employer.)
In-service teachers applying for admission to C2P035 must fill in this section.
In accordance with the Personal Data (Privacy) Ordinance, the information provided here will be released to the applicant on his/her request.
1. I certify that Mr/Mrs/Ms/Miss* is a serving full-time Teacher/Panel Chairperson/
Principal/Others* (please specify
) in my school.
2. Do you recommend # the applicant to study the part-time programme for which he/she applies? Please enter “Y” for Yes or “N” for No.
Please state the reasons below:
Signature of Supervisor/Principal*:
School Seal
Name of Supervisor/Principal*:
(Please use BLOCK LETTER.)
Date:
Regional Education Office (if applicable)
* Please delete whichever is inappropriate.
#
If you recommend your teacher to study the programme, the Institute will assume that you are prepared to make arrangements to support the field experience
activities and school-based work required by the programme.
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For Office Use
Application No.
Please stick the receipt of application fee below:
APPLICATION FEE
Please stick here the original customer copy of the Deposit Slip or ATM Advice
CHECKLIST
Before submitting your application, please check if you have: ✓
filled in the correct programme code(s) and subject code(s);
stuck the receipt of application fee;
attached a copy of each of the academic documents stated in your application;
attached a duplicate set of application form and academic documents for your second choice programme (if applicable);
and
signed and dated the application form.
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