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PROGRAMME ENROLLMENT FORM
(for non-HA Healthcare Professionals only)

Please submit the completed enrollment form, successful applicants will receive a confirmation email and payment advice.

* Required

Part A: Programme Information

Please refer to the corresponding programme title and programme code listed in the web.

Programme Title
Code

Part B: Applicant Information

The provision of personal data by means of submission of this enrollment form is voluntary. The information provided in this enrollment form will be used by HAIHC to process this application only.

Please fill in the following information for the purpose of admission consideration.

Full Name in English (As shown on identification document)
Department / Specialty
Position
Organization
Email Address
Contact Number
Submit

EVALUATION FORM

N160370
17 Nov 2016, 15:00 - 16:00
Dummy Location
* Required
  1. Do you agree that this programme has achieved its stated objectives
    Strongly Disagree
  2. Do you agree that this programme has achieved its stated objectives
    Least
    Most
    Please fill if ...
  3. Do you agree that this programme has achieved its stated objectives
    1. Knowledge of the subjects
      Strongly Disagree
    2. Knowledge of the subjects
      Strongly Disagree
  4. Do you agree that this programme has achieved its stated objectives

Personal Infomation

Name
Rank
Submit

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