*Please attach your CV when submitting this application.
Part 1. PERSONAL INFORMATION
First name (in English):	Tai Man, Peter	Last name (in English):	Chan
Full name (in Chinese):	陳大文	Date of application:	1-Dec-2011
Nationality:	China	Proposed fellowship period:	Jan-Jun, 2011
Email 1:	email1@email1.com	Telephone number 1:	+852 1111 1111
Email 2:	email2@email2.com	Telephone number 2:	+852 2222 2222
Are you a Hong Kong permanent resident?	Yes No	If not, are you eligible to work in Hong Kong?	Yes No
Part 2. EDUCATION
Please provide information on your highest and most relevant qualification attained.
Name of degree:
Name of concentration:
Name of institution:
Country of institution:	Have you graduated?	Yes No
Year of admission:	Year of graduation:
Remarks: (Other professional qualifications)
Part 3. EMPLOYMENT
Please provide information on your current or most recent employment.
Name of employer/company:	Job title:
Country of working:	Date started and ended:
Remarks: (Years of relevant work experience and knowledge of institutional emergency response system in Hong Kong)

Part 4. COURSE(s) AND/OR PLACEMENT APPLIED FOR
In 200 words, describe the course(s) and/or placement applied for to be supported by the fellowship.

Part 5. PROPOSED BUDGET TO BE SUPPORTED BY THE FELLOWSHIP
Please outline the budget for attending the course(s) and/or placement applied for to be supported by the fellowship.

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