The Hong Kong Academy of Nursing
香港護理專科學院
www.hkan.hk
Application of Fellow Membership
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1. Personal Particulars


XXX(X)

2. Academic and Professional Qualifications

(The following entries should be written in descending chronological order)

A. Nursing related Academic & Professional Qualification

Course / Program Title Training Institution / Country Qualification Obtained Year of Award

B. Related Specialty Training

Course / Program Title Training Institution / Country Qualification Obtained Year of Award

3. Post-registration Working Experience in Nursing Relevant to Application

(The following entries should be written in descending chronological order)
From To Position Specialty / Department Working Institution / Hospital

4. Significant Contributions to Nursing Profession (3 most significant ones max.)

(The following entries should be written in descending chronological order)

A. In leadership position of specialty-related activities e.g. in-charge of service or project, or leaders of clinical teams

From To Position Activity Title

B. Invited member in local, national and/or international initiatives e.g. Council Member; invited member of conference / seminar Organizing committee or invited panel member of professional bodies.

From To Position Activity Title

C. Demonstrated contributions in nursing practice and service development e.g. being a specialty mentor, speaker, facilitator, moderator, coordinator or organizer in specialty related training and development programs; or paper submission on innovative nursing practice.

From To Position Activity Title

D. Others Contributions:

5. DECLARATION

  1. I hereby declare that I agree to provide the above information to the Hong Kong College of Nursing and Health Care Management and the information provided in support of this application is accurate to this date.
  2. I understand that the information provided herewith will be forwarded to the Hong Kong Academy of Nursing for processing my membership certification examination application.
  3. I hereby declare that:
    3.1  I been convicted of a criminal offence punishable with imprisonment (irrespective of whether actually sentenced to imprisonment) in Hong Kong or elsewhere.
    3.2  I been found guilty of professional misconduct by any professional body in Hong Kong or elsewhere.
  4. I understand that it is my responsibility to inform the College for any change in the above information, such as place of work, correspondence address and additional related qualification(s), etc. The College will not have to be responsible for any issues arise as a result of my failure to inform.
You have to apply for fellowship within 3 years upon become eligible, otherwise the eligibility would lapse. You also eligible to apply for the 'Fellow Membership' after passing the 'Fellow Exit' Assessment.
Instructions will be sent to you by email about:
  • uploading copy of supportive documents
  • providing information of 2 referees
  • settling the annual membership fee of HK$2,000.00
Incorporated as The Hong Kong Academy of Nursing Limited (http://www.hkan.hk) I prefer to download and submit by printout