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Call for Volunteers to Provide Sustained Care

1) Personal Information

(This question is mandatory)

Salutation

(This question is mandatory)
Surname:
(This question is mandatory)
Given name:
(This question is mandatory)

Chinese name (中文姓名):

(This question is mandatory)
Category
(This question is mandatory)
Affiliated Office / Faculty / Department:
(This question is mandatory)

Study:

(This question is mandatory)

Programme (e.g. BA Social Work, BSc Nursing)

(This question is mandatory)

Year of Study (e.g. Year 2)

(This question is mandatory)

Graduated Programme (e.g. BA Social Work, BSc Nursing)

(This question is mandatory)

Year of Graduation (e.g. 1990)

(This question is mandatory)
Email:
(This question is mandatory)
Telephone Number:
(This question is mandatory)
Are you a registered allied health professional/registered nurse/registered social worker, or other related professional with the relevant registration board?
(This question is mandatory)

Please specify your registered profession (e.g. Registered Social Worker, Registered Nurse, etc.)

(This question is mandatory)
Language Proficiency (able to speak fluently)
(This question is mandatory)

2) Declaration

The personal information collected in this form will be used by The Hong Kong Polytechnic University (PolyU) for purposes relating to your participation in the sustained care projects.

I have read and understood the University’s Privacy Policy Statement and Personal Information Collection Statement.

 

FHSS is currently developing sustained care projects. We may not contact you in the immediate future, but we will reach out if and when a need or relevant plan arises.

 
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