(to be completed at registration or 4-6 months before course, beginning and end of the course and at follow up 請在報名時或課程之前4-6個月,課程開始,課程結束和跟進時完成) Personal Information / 个人資料 Personal information in this section will be encrypted when stored on server, but it is recommended that you submit this form over a private (e.g. home) network.這部分的個人資料會被加密存儲在我們的服務器,但建議你通過專用網絡(例如家裡的網絡)提交此表格。 Last Name (English) 英文姓氏 * First Name (English) 英文名字 * Date of Birth 出生日期 * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year19211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Year Email 電子郵箱 How many children do you have? 您有幾個孩子？ * Time of completion 完成評估的時間 * at registration or 4-6 mo before course 報名時或課程之前4-6個月 beginning of the course 課程開始 end of the course 課程結束 at follow up 跟進 Next Page >
