Section B Assessment Information 乙部評估資料 Part 1. Purpose of Qualifications Assessment 第壹部請選擇申請用途 General Purpose 一般用途 (HK$2,440)

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1 Application Form for Qualifications Assessment 學歷評估申請表格 Applicant may submit the completed application form with assessment fee by mail, in person or by an authorised representative to our office. If applicant chooses.. to submit the form in person or by an authorised representative, please make an appointment before the submission through our Online Appointment Booking System ( An Applicant without an appointment is required to drop-off the application at our reception counter. Late Appointee will only be served within the original reserved timeslot. Please refer to Point 14 of the Guidance Note for Application for details regarding the exact assessment fee. 申請人可將填妥的申請書以及申請費用, 以郵寄親自或由其獲授權代表交回本局以下所述之辦公室如申請人選擇親自或由其獲授權代表遞交申請書, 請提前於本局之網上預約系統 ( 進行預約親臨本局但未有預約之申請人, 可將學歷評估申請遞交至本局接待處未能準時於預約時間開始時到達之申請人, 將只可於原有預約時段內處理申請有關確實需繳交之評估費用, 請參考申請指引內學歷評估要點的第 14 項 Address 地址 : 10 Siu Sai Wan Road, Chai Wan, Hong Kong 香港柴灣小西灣道 10 號 Office Hours 辦公時間 : Monday to Friday 8:45 am to 1:00 pm and 2:00 pm to 5:45 pm (Office is closed during lunch hour from 1:00 pm to 2:00 pm) (except Public Holidays) 星期一至五上午 8:45- 下午 1:00 及下午 2:00- 下午 5:45 ( 午膳時間為下午 1:00 下午 2:00, 辦事處暫停辦公 ) ( 公眾假期除外 ) Telephone Hotline 查詢電話 : (852) Fax Number 傳真號碼 : (852) 電子郵件 : [email protected] Section A Personal Particulars 甲部個人資料 Name in Chinese (if applicable) 中文姓名 ( 如適用 ) *Title (Mr/Mrs/Miss/Ms) * 稱謂 ( 先生 / 太太 / 小姐 / 女士 ) Name in English 英文姓名 ( 姓氏 Surname) The name should be identical to that printed on the applicant s identity card or passport. Please attach the certified true copies or the photocopies of the documents relating to the change of name such as deed poll, adoption certificate, marriage certificate and divorce certificate if the name is different from that/those on the applicant s academic credentials. 姓名須與身份證或護照上的姓名相同如名字與學歷證明文件上的不同, 請附以有關更改姓名文件的核證副本或副本, 如改名契領養證明書結婚證明書及離婚證明書等 *Identity card/passport number * 身份證 / 護照號碼 * Delete where inappropriate 請將不適用者刪去 Contact telephone number(s) 聯絡電話號碼電子郵件 ( 名字 Given name) English mailing address 英文通訊地址 For Official Use Only 只供本局填寫 Fee$ R/N Rec d on: by: Purpose: General ($2,440 ) TR ($2,700) QMAS ($2,900) Corp-I ($2,440 ) Corp-T($2,700 ) Drop-off Mail-in Payment: Cheque # EPS Bank deposit slip T/T Others: Appointment ( Auth) Remarks: All Seen Need to Check: Self-collect( Auth) Post/ Registered Post

. to submit the form in person or by an authorised representative, please make an appointment before the submission through our Online Appointment Booking System (http://qabooking.hkcaavq.edu.hk).

2 Section B Assessment Information 乙部評估資料 Part 1. Purpose of Qualifications Assessment 第壹部請選擇申請用途 General Purpose 一般用途 (HK$2,440) For Teacher Registration or Teacher Appointment 教師註冊或教師聘任用途 (HK$2,700) For Quality Migrant Admission Scheme (QMAS) 優秀人才入境計劃申請用途 (HK$2,900 / US$375) QMAS Reference No.: QMEN- (Please insert a in one of the above boxes 請在以上其中一個格內加上號 ) Part 2. Applicant s educational qualification(s) 第貮部申請人的學歷 Please complete the table below according to the following instructions: 請根據以下指示填寫下列表格 : 1. Please fill in the applicant s highest non-local qualification(s) in the row with Code No. 1 in the following table. Under some circumstances (please refer to paragraphs 2 and 3 below), HKCAAVQ may have to assess other qualification(s) or those learning outcome(s) achieved through learning deemed to have a substantial bearing on the qualification(s) under assessment and these qualification(s)/learning outcome(s) have to be entered in the following table in descending order. 請填寫申請人的最高非本地學歷於以下表格編號 1 的空格內如評審局因應某些情況 ( 見下列第 2 及第 3 段 ) 而需要評估當中對其有重要影響的其他學歷 / 學習, 請將其他學歷 / 學習由最近頒授的開始順序填寫於表格內 2. If the applicant s purpose of assessment (refer to Part 1) is for seeking teacher registration or teacher appointment in Hong Kong, please fill in: - all of the applicant s teacher training qualification(s) (e.g. Bachelor of Education Degree, Diploma in Education, etc.), and - the undergraduate and/or postgraduate qualification(s) (if any). 如果申請人的學歷評估用途 ( 參考第壹部 ) 為教師註冊或教師聘任用途, 請填上 : - 申請人所有的師資培訓學歷 ( 例如教育學學士學位教育文憑等 ), 及 - 本科及 / 或研究院程度的學歷 ( 如有 ) 3. If the qualification contains transferred credits/courses from prior educational qualification(s) attained by the applicant, please check Yes in the last column and fill in the details of the prior qualification(s)/learning in the corresponding row(s) of the table and provide the relevant graduation diploma(s)/certificate(s) and final transcript(s) of the qualifications/credits being transferred. 如申請人的學歷包含由其他之前修讀的學歷所轉移或豁免的學分 / 科目, 請在下列表格的最後一列選擇有, 並在下面的欄中填上之前所修讀的學歷 / 學習資料 ( 包括有關的學分 / 科目轉移及豁免 ) 及提交有關畢業證書及最終的成績單 4. Please provide the relevant documentary evidence, e.g. graduation diploma/certificate and final transcript(s), etc., of each qualification listed below. 請遞交下列每項學歷的證明文件, 包括畢業證書及最終的成績單等 Code No. 編號 Study period (Month/ Year) (From/To) 修讀時期 ( 月 / 年 ) ( 由 / 至 ) Location of Study (e.g. UK/HK) 修讀地方 ( 例如 : 英國 / 香港 ) Mode of Study 上課模式 Name of Award Granting Body and its Place of Origin) 頒授機構名稱及國家 Title of Qualification 學歷名稱 Date of Attainment 頒發日期 Credit/Course Exempted? 學分 / 科目獲豁免? 1 2 (Continued on next page 接下頁 )

Admission Scheme (QMAS) 優秀人才入境計劃申請用途 (HK$2,900 / US$375) QMAS Reference No.: QMEN- (Please insert a in one of the above boxes 請在以上其中一個格內加上號 ) Part 2.

3 Code No. 編號 Study period (Month/ Year) (From/To) 修讀時期 ( 月 / 年 ) ( 由 / 至 ) Location of Study (e.g. UK/HK) 修讀地方 ( 例如 : 英國 / 香港 ) Mode of Study 上課模式 Name of Award Granting Body and its Place of Origin) 頒授機構名稱及國家 Title of Qualification 學歷名稱 Date of Attainment 頒發日期 Credit/Course Exempted? 學分 / 科目獲豁免? Part 3. Teacher Training Qualification(s) (Only applicable for application for Teacher Registration or Appointment purpose) 第叁部請申報申請人的師資培訓學歷 ( 只適用於教師註冊或教師聘任用途之申請 ) Please choose the appropriate item(s) below according to the qualification(s) listed out in Part 2: 請根據第貮部的學歷, 選擇以下適當的選項 :. 1. Does the applicant possess any teacher training qualification? 申請人有沒有任何師資培訓學歷? (Please go to Question 2 請回答問題 2) ((Please go to Question 3 請回答問題 3) 2. The teacher training qualification(s) entered in row Code No.: (Please fill in the appropriate Code No. from the table in Part 2 and continue to answer the questions below.) 師資培訓學歷編號為 : ( 請由第貮部的表格選擇適當的編號填上並繼續回答下列問題 ) The applicant has completed a period of ( weeks and hours*) of supervised teaching practice/ practicum in teacher training before graduation and has provided the documentary proof issued by the granting body for this application Note 1. 申請人已於該師資培訓學歷畢業前完成為期週及小時 * 的教學實習, 並已隨此申請註表附上由頒發機構簽發的教學實習證明文件 1 *Please delete where inappropriate 請刪去不適用者 Note 1 The proof of the supervised teaching practice/practicum has to be issued by the granting body of the teaching training qualification with an official letterhead and stamp, and include the following content: (1) the number of weeks and hours of the supervised teaching practice(s)/practicum; (2) the setting, i.e. kindergarten, primary or secondary schools, of the supervised teaching practice(s) /practicum; (3) the range(s) of age and grade of the students taught in the supervised teaching practice(s)/practicum (applicable to applicants who possess teacher training qualifications in pre-primary or primary education). 註 1 教學實習的證明文件須由學歷的頒發機構以其機構信紙簽發並蓋印, 並列有以下內容 : ( 一 ) 教學實習週數及時數 ( 二 ) 教學實習地點 ( 例如幼稚園小學中學 ) ( 三 ) 教學對象的年齡及年級組別 ( 適用於持有學前或小學教育師資培訓學歷的申請人 ) The applicant cannot provide the documentary proof on the duration of supervised teaching practice/ practicum in this application and understand that this may affect his/her assessment result. 申請人未能隨此申請表附上教學實習的證明文件, 亦明白評估結果或因此受影響

Credit/Course Exempted? 學分 / 科目獲豁免? 3 4 5 Part 3.

4 Does the applicant wish to take part in duties related to pre-primary education (nursery and kindergarten education), no matter whether he/she possesses any teacher training qualification, and would have his/her qualifications be assessed in relation to local pre-primary teacher training qualifications? 申請人無論是否擁有師資培訓學歷, 均希望從事學前教育 ( 幼兒教育及幼稚園教育 ) 工作, 並希望評審局將其學歷與本地學前教育師資培訓學歷作比對? Yes 是 (Please go to Question 4 請往問題 4) No 否 (Please go to Part 4 請往第肆部 ) Please insert a in the appropriate box 請在適當地方加上號 ) 4. If the applicant wishes HKCAAVQ to compare his/her pre-primary teacher training qualification(s) with the local pre-primary teacher training qualifications, please provide details of the applicant s pre-primary teacher training qualification(s), including the syllabus and the synopsis of the content of each subject/ module of the teacher training programme, the course hours of each subject/ module issued by the relevant granting body/bodies. This information can facilitate the assessment of the applicant s pre-primary teacher training qualification(s). 如申請人希望本局將其學歷與本地學前教育師資培訓學歷作比對, 請提供申請人的學前教育師資培訓學歷的詳情, 包括由有關師資培訓機構印製的課程大綱每科 / 單元之內容簡介每科 / 單元之課時的證明文件這些資料能幫助本局評估申請人的學前教育師資培訓學歷 The applicant has provided the above-mentioned documents for this application. 申請人已隨本申請表附上上述文件 The applicant cannot provide in this application the above-mentioned documents and understand that this may affect his/her assessment result. 申請人未能隨本申請附上上述文件, 亦明白評估結果或因此受影響 Please insert a in the appropriate box 請在適當地方加上號 ) Part 4. Means to Collect the Report for Qualifications Assessment. 第肆部領取評估報告的方法 For General or Teacher Registration/Appointment Purposes. 如閣下之申請為一般用途或教師註冊或聘任用途之申請, 請註明欲取得評估報告的方法 In person or by authorized representative (please complete Appendix A) 親身或授權他人 ( 請填妥附錄甲 ) By surface mail 平郵 By registered mail 掛號郵件 (Please refer to Point 14 of the Guidance Note for the extra fee for registered mail 有關掛號郵件的附加費用, 請參考申請指引內的第 14 項 ) For Quality Migrant Admission Scheme (QMAS), the assessment result will be sent by registered mail. 優秀人才入境計劃申請用途之申請, 評估報告將以掛號郵件形式寄出 If your documents have not been certified or you have provided additional document(s) after submitting your application, you might be required to pick up the report at our office. 如申請人於遞交申請及評估過程中未能出示所有所需文件的正本或核證副本, 申請人將可能有需要到評審局領取評估報告 Please insert a in the appropriate box 請在適當地方加上號 ) WARNING 警告事項 A person who, either orally or in writing, makes any statement or representation or furnishes any information to HKCAAVQ or a review committee in connection with the performance of its functions under the HKCAAVQ Ordinance (Chapter 1150) which the person knows or reasonably ought to know is misleading or false in a material respect commits an offence and is liable on conviction to a fine at level 5. 任何人在與評審局根據香港學術及職業資歷評審局條例 ( 第 1150 章 ) 執行其職能有關連的情況下, 向評審局或覆檢委員會作出該人明知或理應知道在要項上具誤導性或屬虛假的任何口頭或書面陳述或表述, 或以口頭或書面提交該人明知或理應知道在要項上具誤導性或屬虛假的任何資料, 即屬犯罪, 一經定罪, 可處第 5 級罰款

have his/her qualifications be assessed in relation to local pre-primary teacher training qualifications?

5 Section C Declaration 丙部聲明 I (English full name) have carefully read, fully understood and accepted all the terms in Guidance Notes for Application for the Qualifications Assessment. I declare that the information provided in this application form is true and complete to the best of my knowledge and belief, and all documents produced and/or submitted for this application are genuine documents or their certified true copies. I authorise and consent to HKCAAVQ making any necessary enquiries, which requires releasing my personal information provided in this application, for purposes relating to qualifications assessment. I also authorise and consent to relevant organisations / agencies to release any record or information to HKCAAVQ as may be required for these enquiries. 本人 ( 中文全名 ) 已細閱學歷評估的申請指引, 並完全明白其內容及接受其中所有條款現特此聲明, 本人在此申請表格所提供的各項資料, 盡本人所知及所信, 均真確詳盡, 而就此申請所出示及 / 或提交之文件, 均為真實文件或其核證副本本人授權及同意評審局可就學歷評估的有關事宜進行查詢時, 向有關組織 / 機構透露本人在申請表內提供的個人資料本人亦授權及同意有關組織 / 機構可就這些查詢, 向評審局透露任何有關的紀錄及資料 Signature of the applicant 申請人簽署 Date of signature 簽署日期 For Acknowledgement of Receipt of Report for Qualifications Assessment (if applicable) 確認領取評估報告 ( 如適用 ) I acknowledge receipt of the Report for Qualifications Assessment (HKCAAVQ reference: ) 本人已收到學歷評估報告 ( 參考編號 ) Signature of the applicant/authorised representative* 申請人 / 獲授權代表簽署 * Date of signature 簽署日期 * Delete where inappropriate 請將不適用者刪去

genuine documents or their certified true copies.

6 - 6 - Appendix A 附錄甲 Authorisation for Submission of Application Form for Qualifications Assessment and/or Collection of Report for Qualifications Assessment I, (Name of applicant), holder of *identity card/passport number (1), hereby authorise *Mr/Mrs/Miss/Ms, holder of *identity card/passport number (2) (Telephone number ): to submit my Application Form for Qualifications Assessment and the required documents. to collect my Report for Qualifications Assessment. Signature of the applicant (3) Date Insert a in the appropriate box * Delete where inappropriate 遞交學歷評估申請表格及 / 或領取學歷評估報告授權書本人 ( 申請人姓名 ),* 身份證 / 護照號碼持有人 (1), (2) 現授權 * 先生 / 太太 / 小姐 / 女士 * 身份證 / 護照號碼持有人 ( 電話號碼 ): 遞交本人之學歷評估申請表格及所需文件領取本人之學歷評估報告 (3) 申請人簽署日期請在適當的空格中加上號 * 請將不適用者刪去 Notes 附註 : (1) Please attach a copy of the applicant s identity card or passport. 請附上申請人的身份證或護照副本 (2) The authorised representative is required to present his/her identity card or passport for identification purpose. 獲授權代表須出示其身份證或護照以證明其身份 (3) The signature of this authorisation must be the same as that signed by the applicant in the Application Form for Qualifications Assessment. 在本授權書的簽名式樣必須和學歷評估申請表格上的相同

the required documents. to collect my Report for Qualifications Assessment.

7 - 7 - Appendix B 附錄乙 Checklist for Documents/Evidence Required for Application for Qualifications Assessment 申請學歷評估所需文件 / 證明核對表 Application Form 學歷評估申請表格 Duly completed application form 填妥的申請表格 A set of copies / certified true copies of the following documents/evidence applicable to your application 以下符合閣下申請所需之所以文件 / 證明的複印件 / 核證副本 Educational Credentials Documents 學歷證明文件 Graduation certificates/diplomas and final transcripts 畢業證書和最終的成績單 Public examination certificates and result statements (final versions) 公開考試證書和最終的成績單 Pamphlet of the educational programme leading to the qualification under assessment (if available). 有關學歷的課程簡介資料 ( 如有 ) Teacher Training Documents (For the purposes of teacher registration or teacher appointment) 師資培訓文件 ( 教師註冊或教師聘任用途 ) Documentary proof(s) of supervised teaching practice(s)/practicum issued by the granting body of the qualification with an official letterhead and stamp, including the following content: (1) the number of weeks and hours of the supervised teaching practice(s)/practicum; (2) the setting, i.e. kindergarten, primary or secondary schools, of the supervised teaching practice(s)/practicum; (3) the range(s) of age and grade of the students taught in the supervised teaching practice(s)/practicum (applicable to applicants who possess teacher training qualifications in pre-primary or primary education). 由學歷的頒授機構所發出的教學實習證明, 該證明須以頒授機構的信紙所發出並由機構蓋章, 內容包括 : ( 一 ) 教學實習週數及時數 ( 二 ) 教學實習地點 ( 例如幼稚園小學中學 ) ( 三 ) 教學對象的年齡及年級組別 ( 適用於持有學前或小學教育師資培訓學歷的申請人 ) The syllabus and the synopsis of the content of each subject/ module of the teacher training programme plus the course hours of each subject/module (only applicable to applicants who wish to assess qualifications in relation to pre-primary teacher training qualifications) 師資培訓課程大綱和每科 / 單元之內容簡介, 以及每科 / 單元之課時 ( 只適用於擬進行學前教育師資培訓學歷評估的申請人 ) Evidence of the Payment of Assessment Fee (for mail-in applications) 繳費證明 ( 郵寄申請適用 ) Bank deposit slip, crossed cheque, or telegraphic transfer evidence 銀行存款單據劃線支票或電匯證明 Other Documents (if applicable) 其他文件 ( 如適用 ) Photocopies of ID Card / Passport 身份證 / 護照影印本 Documents certifying the change in names, e.g. deed poll, adoption certificate, marriage certificate and/or divorce certificate, etc. 改名證明, 例如 : 改名契領養證明書結婚證明書離婚證明書等 Certified Chinese or English translations for documents written in languages other than Chinese or English 中文或英文核證翻譯本 ( 如文件並非以中文或英文寫成 ) Duly completed Authorisation for Submission of Application Form for Qualifications Assessment and/or Collection of Qualifications Assessment Result (Appendix A). The authorised representative is required to present his/her identity card or passport, and a copy of the applicant s identity card or passport. 填妥的遞交學歷評估申請表格及 / 或領取學歷評估結果授權書 ( 附錄甲 ) 獲授權代表須出示其身份證或護照, 以及申請人的身份證或護照副本

Educational Credentials Documents 學歷證明文件 Graduation certificates/diplomas and final transcripts 畢業證書和最終的成績單 Public examination certificates and result statements (final versions) 公開考

8 Please fill in the boxes below 請填寫以下空格 Appendix C 附錄丙姓名 Name 地址 Address 姓名 Name 地址 Address Acknowledgement of Application for Qualifications Assessment 學歷評估申請覆函 HKCAAVQ writes to acknowledge receipt of the application for Qualifications Assessment from the following applicant on / / (day/month/year). 茲收到以下申請人於 / / ( 日 / 月 / 年 ) 提交的學歷評估申請, 本局現正處理中 Name 姓名 Address 地址 The assessment will take about 15 working days starting from the next working day of this acknowledgement. However, if further information or research is required during the assessment process, you are required to provide further information if necessary and the assessment process may take longer. We reserve the right to terminate the application if the required information/certification and/or documentary evidence cannot be provided by the applicant or obtained from relevant bodies after a period of 2 months. You will be informed upon completion of the assessment. 評估工作將由此覆函發出的下一個工作天起計, 約需十五個工作天若評估主任於評估過程中需要更多資料或作進一步調查, 你或需提供更多資料以協助我們處理該宗申請, 而評估時間或因此延長如我們未能於兩個月內從你或有關機構獲得所需資料及 / 或文件, 我們有權終止處理該宗申請當評估完成後, 你將會接獲通知 For enquiries, please contact HKCAAVQ during the office hours from Monday to Friday 8:45 am to 1:00 pm and 2:00 pm to 5:45 pm (Office is closed during lunch hour from 1:00 pm to 2:00 pm) at (852) 如有任何查詢, 可於辦公時間 ( 星期一至五上午 8:45- 下午 1:00 及下午 2:00- 下午 5:45 午膳時間為下午 1:00 下午 2:00, 辦事處暫停辦公 ) 致電 (852) 向本局查詢 Hong Kong Council for Accreditation of Academic and Vocational Qualifications 香港學術及職業資歷評審局 (Valid only with the official stamp of HKCAAVQ) ( 必須有評審局之印章方為有效 )

茲收到以下申請人於 / / ( 日 / 月 / 年 ) 提交的學歷評估申請, 本局現正處理中 Name 姓名 Address 地址 The assessment will take about 15 working days starting from the next working day of this acknowledgement.

所 3 學分課程, 及兩門跨領域課程共 6 學分以上課程學生在修課前, 必須填寫課程修課認定表, 經班主任或指導教授簽名後始認定此課程學分 ) 10. 本規章未盡事宜, 悉依學位

所 3 學分課程, 及兩門跨領域課程共 6 學分以上課程學生在修課前, 必須填寫課程修課認定表, 經班主任或指導教授簽名後始認定此課程學分 ) 10. 本規章未盡事宜, 悉依學位 95 年訂定 96 年 11 月修正 97 年 10 月修正 100 年 2 月修正 101 年 4 月修正 102 年 1 月修正 103 年 4 月修正 103 學年度入學新生適用, 舊生可比照適用 1. 研究生須於入學後第二學期開學前選定指導教授, 經課程委員會認定後方得繼續

Section B Assessment Information 乙 部 評 估 資 料 Part 1. Purpose of Qualifications Assessment 第 壹 部 請 選 擇 申 請 用 途 General Purpose 一 般 用 途 (HK$2,440)

Section B Assessment Information 乙部評估資料 Part 1. Purpose of Qualifications Assessment 第壹部請選擇申請用途 General Purpose 一般用途 (HK$2,440)