Teacher Fellowship Programme Application Form
Instruction
This application form must be completed by the applicants.
Please fill in all required fields. Incomplete applications will not be reviewed.
Application forms may be submitted either:
- Online ( OR
- By mailing a completed Microsoft Word file. The original signed copy of the completed application form, which includes a signed declaration statement, should be sent to:
Mr. William Chiu
The Hong Kong Jockey Club
One Sports Road, Happy Valley, Hong Kong
Please also send the scan copy of the completed and signed application form and the declaration statement to
Application deadline
The signed and completed application form must be received by The Hong Kong Jockey Club on or before 20 October 2017.
Personal Information
*Title:
*Last Name in English:
*First Name in English:
*Full Name in Chinese:
*Date of Birth (MM / YYYY):
*Nationality:
*Are you a permanent Hong Kong resident?
*HKID / Passport Number:
Contact Information
*Contact Phone Number.:
*Email Address:
*Home Address:
Education
*Name of Institution:
*ProgrammeName:
*Date of Completion (MM / YYYY):
+ please addothereducation information as necessary.
Teacher Qualification
*Teacher Registration Number:
+ please attach proof as you submit this form.
Other Qualifications / Awards
1. Name of Qualification / Award:
Name of AwardingOrganisation:
Year of Award:
Description:
(Max. 200 words)
+ please add additional qualification / award information as necessary.
Employment
*Are you currently employed be a school as a teacher?
Please begin with the current employment
1. *Name of School/ Employer(English):
*Name of School/ Employer (Chinese):
*FinancialType: ○Government ○Aided ○DirectSubsidyScheme
*Current school: ○Yes ○No
* Employment Period from: to:
*Work Title:
*Your Roles:
*Level of students and subjects you teach:
*Your main achievements (Max. 200 words):
2. Name of School / Employer (English):
Name of School / Employer (Chinese):
Financial Type: ○Government ○Aided ○Direct Subsidy Scheme
Current school: ○Yes ○No
Employment period from: to:
Work Title:
YourRoles:
Level of students and subjects you teach:
Your main achievements(Max. 200 words):
+ pleaseadd additional employment information as necessary.
References
Please list out 2 referees. The first referee must representthe management of your current school.The second referee can be anyone, such as your fellow teacher, parents, or even students.
1.*Title:
*Name of Referee: *Work Title:
*Organisation: *
*ContactNumber: *Contact Email:
2.*Title:
*Name of Referee: *Work Title:
*Organisation: *
*ContactNumber: * Contact Email:
+ please attach reference letters or relevant documentation when you submit this form
Please note that the organiser may contact the referees for additional information if your application is shortlisted for further processing.
(Please check the box)
☐I confirm that my application to participate in this programme has been endorsed by my school
management and that I have fully briefed them about the content, subsidy support and commitment
under the programme.
Buddies Recommendation
All changemakers need buddies – fellow teachers who support you on your learning journey and your subsequent innovative education initiative. They will join you to attend the early stage of the Sabbatical andthe 2-week overseas trip, andwill work with you as a team to implement your innovative initiativesand bring positive changes in your school.Please recommend two co-workers – who must be teachers at your school – to be your buddies.
1. *Title of Buddy:
*Name of Buddy: *Work Title:
*Roles at school:
* Level of students & subjects he/she teach:
*Reasons why he/she is invited to join you:
* If given a chance, what change would you initiate in your school? (Please have this question answered by your co-worker):
*Contact Number: *Contact Email:
*Teacher Registration Number:
+ please attach proof as you submit this form.
2. *Title of Buddy:
*Name of Buddy:*Work Title:
*Roles at school:
*Level of students & subjects he/she teach:
*Reasons why he/she is invited to join you:
* If given a chance, what change would you initiate in your school? (Please have this question answered by your co-worker):
*Contact Number: *Contact Email:
*Teacher Registration Number:
+ please attach proof as you submit this form.
Self-introduction
*Write a short statement below to briefly introduce yourself and explain to us why you would like to become a Teacher Fellow.
(Word limit for the written introduction is 300 for English and 250 for Chinese)
Essay Questions
Please use either English or Chinese to respond to the following questions. Please keep your answers at an appropriate length.
- *Why did you become a teacher? What are your dreams and goals as a teacher?
你為什麼成為老師?你的教學夢想和目標是什麼?
- *Are you creative and innovative? Describe yourself and your pathway to becoming who you are. For example, have you undertaken projects could be considered as innovations in education?
你有創意及願意創新嗎?請描述你自己及你的成長歷程，例如你過去曾推展過被認為是教育創新項目的經驗。
- *What changes do you want to see in your school? Please share if you have an initial framework for the innovative and educational idea that you wish to try and implement at your school.
你希望為學校帶來什麼改變? 對於你希望在校內嘗試及實踐的教育創新，你有沒有初步的構想?
- *Why is this idea important? What outcome and impact do you expect to see?
為什麼這構想如此重要? 你期望得到怎樣的結果和帶來什麼影響?
- *What challenges and difficulties do you foresee in the process? What kind of support do you expect from your school and other stakeholders to implement this Idea?
你認為在實踐改變的過程中會遇到什麼困難?你希望從學校及其他持份者得到怎樣的支持來實踐這個構想?
6. *Finally, please describe to us an issue in education that you have reflected on and are concerned with. Please also tell us how you think this issue can be addressed with participation from and engagement of more teachers.
請描述你關注的教育議題，並建議如何透過更多教師的參與及合作來應對這議題。
Declaration
I understand that the provision of all personal information requested in this form is obligatory and failure to provide such information and the required documents may affect the processing and outcome of the application for the “InnoPower@JC: Fellowship for Teachers and Social Workers” (the “Fellowship Programme”). I declare that the information provided in this application is, to the best of my knowledge, complete and accurate. Any misrepresentation may lead todisqualification.
I declare that I have read and fully understand and agree with the contents of the Privacy Policy Statement of the Trust ( Without limiting the generality of the contents of the Privacy Policy Statement:
(a) I authorise any organisation or employer identified in this application form to release all information provided in this form to the Trust, the Club and/or other partners, supporting organisations or any other third party collaborating with the Trust in the Fellowship Programme (the “Collaborators”) for verification of such information, and to provide reference as requested by the Trust, the Club and/or the Collaborators to support this application.
(b) I understand that if I was successful in the application:
- I agree that the Trust or the Club may pass my personal information, including but not limited to my name, contact details, educational and professional background, to the Collaborators for future communication and engagement purposes.
- I am required to attend the award presentation ceremony and other events or ceremonies relating to the Fellowship Programme.
- My name and educational and professional background may be publicised by the Trust, the Club and/or the Collaborators via various channels (such as websites, social media platforms, publications and other public channels) for the purpose of promoting or reporting of the Fellowship Programme.
(*Please check the following boxes)
☐I agree and understand the above Declaration.
☐ I read and confirm the frequently asked questions ()
Before you send the form please be reminded to attach a certified copy of these documents:
- Your own and your buddies’ Teacher Registration certificate
- Proof of support from your school management
- Any reference letter or supporting documentation
*Your signature:______
(Your name in print:)
(Date: )
* Compulsory fields