Professional Certificate Programme in Biostatistics

Professional Certificate Programme in Biostatistics - Application Form (2022-2023)

Name Name * First Last
Chinese Name
Sex

Sex Male Female
HKID Card No.
Passport No. (if you do not have a HKID Card)
Passport Expiry Date Passport Expiry Date / MM / DD YYYY
Nationality *
Place of Birth *
Date of Birth Date of Birth * / MM / DD YYYY
Mobile Number *
Email *
Home Address Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country/Region
Academic Qualifications (Institution and Location) *
Professional Qualifications (Awarding Body and Year Obtained) *
Working Experiences (Institution, Position and Years in the Position) *
Declaration:

1. I hereby declare that the information provided in this form and relevant documents attached are correct to the best of my knowledge.
2. The Application fee paid by crossed cheque made payable to "The Chinese University of Hong Kong" will be sent to Room 202, 2/F, School of Public Health Building, Prince of Wales Hospital, Shatin, N.T. (Professional Certificate Programme in Biostatistics 2022)
3. I understand that the Application fee (HK$300), once paid, is not refundable.
4. I understand that the Programme fee, once paid, is not refundable.
I agree to the above terms as listed in the declaration. *

I agree to the above terms as listed in the declaration. Yes No
HKID Copy *

Attach Files
Transcripts *

Attach Files
Certificate

Attach Files
Other Supporting Documents

Attach Files
I will send the following to Room 202, 2/F, School of Public Health Building, Prince of Wales Hospital, Shatin, N.T. with subject: Professional Certificate in Biostatistics 2022 / 23 Application *

I will send the following to Room 202, 2/F, School of Public Health Building, Prince of Wales Hospital, Shatin, N.T. with subject: Professional Certificate in Biostatistics 2022 / 23 Application HK$300 application fee in crossed cheque
Signature *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Disclaimer The personal data collected will be used by School of Public Health - Master of Science in Epidemiology and Biostatistics Programme (SPH__MSEBP) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.

Professional Certificate Programme in Biostatistics - Application Form (2022-2023)

Declaration: