Application for Pre-approval Overseas Training

Name: (English) _______________________________  (Chinese)  ________________________
		     (SURNAME IN BLOCK LETTERS)

Trainee No: ______________________    Position Code No:______________________________

Work Address:  __________________________________________________________________

		   __________________________________________________________________

Tel : ____________  Pager : ______________  Fax : ______________  Email: ________________
________________________________________________________________________________
			       
Details of Overseas Training

Training Duration: ________________________________________________________________

Training Center: __________________________________________________________________

Overseas Training Supervisor:_______________________________________________________

Details of the Training Program: 
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Trainee’s signature:_________________________         	Date:___________________________

Educational Supervisor:______________________		Date:___________________________

Please attach relevant documents for TEC’s consideration of your application.

Completed form should be sent to Dr. WONG Chi Kin Felix, Secretary, Training and Examinations Committee, c/o Division of Chemical Pathology, KLG2, Queen Mary Hospital, Pokfulam, Hong Kong. Tel : (852) 2255 1293
Email: wck457@ha.org.hk