2023 Professional Certificate Programme in Health System Leadership

2023 Professional Certificate Programme in Health System Leadership - Online Application

Module 1: 3-7 July 2023 (5 days onsite training)
Module 2: July - Sep 2023 (10 weeks distance coaching)
Module 3: 9-13 Oct 2023 (5 days onsite training)
* The duration of Module 3 is subject to change.

Please read the "Notes for Local/Non-local Applicants" in programme website before submit your application https://www.hsl.sphpc.cuhk.edu.hk/admission

Deadline: 31 May 2023 (local) / 30 Mar 2023 (non-local)

Are you a local or non-local applicant? *

Are you a local or non-local applicant? Local Applicant (i.e. Hong Kong) Non-local Applicant (i.e. outside Hong Kong)
Are you nominate by the local organisation below? *

Are you nominate by the local organisation below? Department of Health (Hong Kong) Hospital Authority Head Office Hospital Authority Cluster Not applicable
Section 1: Personal Information
Title *

Title Prof. Dr. Mr. Ms.
English Name English Name * First Last
First Name: CHAN
Last Name: Tai Man
Chinese Name *
Sex *

Sex Male Female
Date of Birth Date of Birth * / MM / DD YYYY
Mobile Number *
Email *
Nationality *
Place of Birth *
Hong Kong ID Card No. (Local applicant only)

Sample: A123456(7)
Passport No (Non local applicant only)
Passport Expiry Date (For Non local applicants only) Passport Expiry Date (For Non local applicants only) / MM / DD YYYY
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country/Region
Section 2: Academic Qualifications (List the highest qualification first)
Academic Qualification 1
Institution/Location/Date of Attendance/Major or minor/Name of degree *
Academic Qualification 2
Institution/Location/Date of Attendance/Major or minor/Name of degree
Academic Qualification 3
Institution/Location/Date of Attendance/Major or minor/Name of degree
Section 3: Professional Qualifications
Professional Qualification 1 (Name of Qualification/Award Institution and country/Date of Award) *
Professional Qualification 2 (Name of Qualification/Award Institution and country/Date of Award)
Professional Qualification 3 (Name of Qualification/Award Institution and country/Date of Award)
Section 4: Working Experience (List the current first)
Working Experience 1 (Institution and location/Position/Year From-to) *
Working Experience 2 (Institution and location/Position/Year From-to)
Working Experience 3 (Institution and location/Position/Year From-to)
Section 5: Expectation and Source of Information
Expectation of the Programme *
Source of Information *

Source of Information Programme Website Programme Leaflet CUHK Email Colleague/Alumni/Friend HA/DH Email Other Other
Section 6: Supporting Documents Checklist (*Mandatory)
I will send the following supporting documents soft copies to healthadmin@cuhk.edu.hk with Email Subject: HSL 2023 Application - Your Full Name *

I will send the following supporting documents soft copies to healthadmin@cuhk.edu.hk with Email Subject: HSL 2023 Application - Your Full Name Photocopy of Bachelor or above Graduation Certificate(s)* Photocopy of Qualification Certificate(s)* Recommendation letter Personal statement indicating your background and interest in the Programme* Recent Photo (For Local) Photocopy of Identity Card* (For Local & By post) HK$100 Cheque Application fee payable to "The Chinese University of Hong Kong" (Please write your name, contact number and "Application fee for HSL" at the back of the cheque) (For Non-local) Photocopy of Passport and Citizen ID Card* (For Non-local) Curriculum Vitae*

Post address: Room 202, 2/F, School of Public Health, Prince of Wales Hospital, Shatin (HSL 2022)
Section 7: Declaration
Declaration:
1. I understand that no refund will be made after receipt of payment.
2. I read the “Notes for Local/Non-local Applicants”
3. I understand insufficient supporting documents will delay the application process.
4. I understand applicants should affix sufficient stamps on the envelope (according to Hongkong Post, mails with insufficient postage may not be delivered. To avoid delay in the application process, please make sure that your application package bears sufficient postage by weight and mail format
5.I declare that the information given in support of this application is accurate and complete, and understand that any misrepresentation will result in the disqualification of my application for admission.
6.I agree to the above terms as listed in the declaration.

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 Health Services Management Programme (SPH__MSHSMP) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.

2023 Professional Certificate Programme in Health System Leadership - Online Application

Section 1: Personal Information

Section 2: Academic Qualifications (List the highest qualification first)

Section 3: Professional Qualifications

Section 4: Working Experience (List the current first)

Section 5: Expectation and Source of Information

Section 6: Supporting Documents Checklist (*Mandatory)

Section 7: Declaration