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Application for Registration / Restoration
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HKIA Registration Online Application
Please read the
Quick Application Guidelines
before filling in the form.
I. Personal Information
Title
*
Ms
Mr
Miss
Mrs
Dr
Given Name
*
Family Name
*
中文姓名
Nationality
0 / 100
Email Address
*
Confirm Email Address
*
Contact Phone
*
Mobile Phone
*
Fax
Permanent Address
*
0 / 200
II. Work Information
Organisation Name
*
0 / 250
機構名稱 (中文)
0 / 30
Job Position
*
0 / 100
Job Description
*
0 / 400
Phone
*
Fax
Address
*
0 / 200
機構地址 (中文)
0 / 40
Years of Practice as an Audiologist Following Professional Qualification
(Enter "0" if you have never practiced in the region)
Hong Kong
*
Overseas
*
III. Correspondence Address
Same as permanent address
Same as organisation address
Other (please specify below)
Address (Other)
0 / 400
IV. Academic Qualification
Highest Academic Qualification
*
Institution
*
Year Obtained
*
Relevant Professional Qualification in Audiology
Institution
Year Obtained
Clinical Practicum
*
Included in the Postgraduate Programme
Passed an examination on clinical competence of audiology practice
Obtained the right of audiology practice where the professional qualification was acquired (please specify below)
Please specify where your professional qualification was acquired
Supplementary Information
V. Continuing Professional Development
No. of Continuing Professional Development (CPD) Hours obtained in the Past 12 Months in activities recognised by HKIA
*
VI. Professional Indemnity Insurance Coverage
Do you have valid and individually named professional indemnity insurance coverage?
*
Yes, I have valid and individually named professional indemnity insurance coverage.
No, I do not have valid and individually named professional indemnity insurance coverage.
VII. Declaration
Declarations 1-5
Check every item that applies
Declaration 1
*
I have provided true copy of all documents required for application for registration in the Register held by the Hong Kong Institute of Audiologists Limited.
Declaration 2
*
I agree to have my name and accreditation status disclosed through the Register and the HKIA website.
Declaration 3
*
I agree to have my information, in anonymised, aggregated, and generalised form, compiled for statistical purposes and disclosed to the independent accreditation agent and other government departments, bureaux, agencies, and authorities if required.
Declaration 4
*
I agree to comply with the Code of Ethics for Audiologist in Hong Kong.
Declaration 5
*
I declare that the information given in this application is correct to the best of my knowledge and belief.
Submit
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