JA Career Dimensions 4.0 Application Form 2022/23
Please complete this form and submit to JA.
請填妥以下表格，並交回JA。

The program target to empower disadvantaged students by providing them extra learning opportunity, students who are receiving Comprehensive Social Security Assistance or eligible for the Government Financial Assistance Schemes (Full / Half) are welcome to join us.
活動旨在指引基層同學提供更多學習機會，歡迎合資格領取綜緩、全額或半額學生資助的同學參加

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School Information 學校資料
English Name 英文名稱 *
Chinese Name 中文名稱 *
English Address 英文地址 *
Street No. & Street
*
District 地區
*
HK/KLN/NT
Chinese Address 中文地址 *
School Tel 學校電話 *
School Fax 傳真號碼 *
School Website 學校網址
Head of School 校長
English Name 英文姓名 *
Sal 稱呼
*
Surname 姓
*
First Name 名
Chinese Name 中文姓名 *
Email Address 電郵地址
Office Tel. No. 辦公室電話
Link Teacher 負責老師
English Name 英文姓名 *
Sal 稱呼
*
Surname 姓
*
First Name 名
Chinese Name 中文姓名 *
Position 職位 *
Office Tel No. 辦公室電話 *
Mobile No. 手提電話 *
Email Address 電郵地址 *
Expected number of participating student 預算參與學生人數
*Actual number of participating students in JA Career Dimensions 4.0 will be notified on a later date.
實際可參與「JA 職業新世代4.0」的學生人數會容後通知。

**students who are receiving Comprehensive Social Security Assistance or eligible for the Government Financial Assistance Schemes (Full / Half) have priority to join the workshop. All Form 4 - Form 6 students are welcome to join us.
合資格領取綜緩、全額或半額學生資助的同學可優先參加。所有中四至中六同學均歡迎參加。
Form 4 中四
Number of Student 學生人數
Form 5 中五
Number of Student 學生人數
Form 6 中六
Number of Student 學生人數
Language of Instruction 授課語言 *
Preferred Program Date 工作坊日期 *
MM
/
DD
/
YYYY
Declaration 聲明
I declare that the information given in this application is true and accurate, and confirm that this application has been endorsed and supported by the school. I hereby authorise Junior Achievement Hong Kong (JA) to contact relevant parties and verify information given in this application form.

本人聲明此申請表格內之資料屬實及準確，並確定此申請已得到校方認可及支持。本人謹此授權青年成就香港部與有關人士聯絡，核實申請表格內之資料。
Notes 備註�：
* JA reserves all rights to change the workshop dates. JA 保留權利更改工作坊日期
* Please print a copy of this completed form for your record before submitting this form. 遞交前，請先列印已填妥的申請表以作記錄。
I totally understand and accept the statement as above. 本人完全明白及同意上述聲明。 *
Contact person 聯絡人姓名 *
Position 職位 *
Date 日期 *
MM
/
DD
/
YYYY
How do you know about this program? 從哪渠道得知此課程？
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