1
小一入學申請編號POA APPLICATION NO.
甲部：申請兒童資料
PART A: APPLICANT CHILD’S PARTICULARS
教育局 EDUCATION BUREAU
小一入學申請表 (2023) (下載版本)APPLICATION FORM FOR ADMISSION TO PRIMARY ONE (2023) (DOWNLOADABLE VERSION)
此表格只適用於申請官立或資助小一學位
THIS FORM IS TO BE USED FOR APPLICATION FOR ADMISSION TO PRIMARY ONE IN A GOVERNMENT OR AIDED PRIMARY SCHOOL ONLY
填寫此表格前請參閱「填表須知」及「填寫下載版本申請表須知」
PLEASE READ CAREFULLY “NOTES ON HOW TO COMPLETE THE APPLICATION FORM” AND “NOTES ON HOW TO COMPLETE THE DOWNLOADABLE APPLICATION FORM” WHEN COMPLETING THIS FORM
1 住址所屬 小一學校網編號 POA SCHOOL NET NO.
OF HOME ADDRESS
2 姓名（中文） 3 證件編號
DOCUMENT NO.
證件類別
DOCUMENT TYPE NAME (IN ENGLISH)
4 性別
SEX
男(M) 女(F)
5 出生日期
DATE OF BIRTH
日
D D
月
M M
年
Y Y Y Y 6 有特殊教育需要的兒童
CHILDREN WITH SPECIAL EDUCATIONAL NEEDS
7 不能以中文 作為學習媒介
CANNOT USE CHINESE AS LEARNING MEDIUM
8 通訊地址
CORRESPONDENCE ADDRESS 室 FLAT 樓 FLOOR 座BLOCK
大廈名稱
BUILDING NAME
屋邨 / 村名稱
ESTATE/VILLAGE
街道名稱及號數
NO. AND STREET NAME
區
DISTRICT
香港 九龍 新界 國內
HK KLN NT Mainland
China
居住地址
RESIDENTIAL ADDRESS
_____________________________________________________________________________________________
(如與通訊地址相同，則不須填寫) (Leave blank if same as correspondence address)
乙部：家長 / 監護人資料
PART B: PARENT/GUARDIAN’S PARTICULARS
9 姓名（中文） 10 證件編號
DOCUMENT NO.
證件類別
DOCUMENT TYPE NAME (IN ENGLISH)
11 住宅電話
HOME TEL. NO.
12 與申請兒童關係
RELATIONSHIP WITH
APPLICANT CHILD
________________
13 教育局專用
FOR OFFICE USE ONLY
A B
日間聯絡電話/手提電話
DAY TIME CONTACT TEL. NO. / MOBILE PHONE
電郵地址
EMAIL ADDRESS
（可選擇填寫 - 作啟動小一入學電子平台帳戶之用，詳情請參閱「小一入學申請表」填表須知）
（Optional- for account activation of the POA e-Platform. Please refer to the Notes on How to Complete the “Application Form for Admission to Primary One” for details）
丙部：申請學校自行分配學位者始需填寫
PART C: TO BE COMPLETED ONLY IF APPLYING FOR A DISCRETIONARY PLACE
14 學校授課時間*
SCHOOL SESSION
學校專用
FOR SCHOOL USE ONLY
申請的小學名稱
NAME OF SCHOOL APPLIED FOR: _____________________________________________________________________________
上午 AM
下午 PM
全日 WD
15 學校編號
SCHOOL NUMBER
（甲） 兄/姊在該小學就讀或父/母在該小學就職
(A) SIBLING(S) STUDYING OR PARENT(S) WORKING IN THE PRIMARY SCHOOL APPLIED FOR
16 是
YES
父/母 或 兄/姊姓名*
NAME OF PARENT / SIBLING
____________________
現讀班級
CLASS ATTENDING
______________
若沒有兄/姊在該小學就讀或父/母在該小學就職，則填（乙）項。
IF SIBLING(S) NOT STUDYING OR PARENT(S) NOT WORKING IN THE PRIMARY SCHOOL APPLIED FOR, PLEASE COMPLETE TYPE (B).
（乙） 依計分辦法準則分配的自行分配學位。申請兒童只能在一至五項及/或六至七項中各選一項填報。
(B) DISCRETIONARY PLACES ALLOCATED ACCORDING TO POINTS SYSTEM. APPLICANT CHILDREN CAN ONLY CLAIM ONE ITEM FROM 1 TO 5 AND/ OR ONE ITEM FROM 6 TO 7.
1. 父/母全職在與該小學同一校址的幼稚園或中學部工作
PARENT(S) TEACHING OR WORKING FULL-TIME IN THE KINDERGARTEN OR SECONDARY SECTION IF IT IS OF THE SAME ADDRESS AS THE PRIMARY SCHOOL
(二十分)
(20 POINTS)
17
父/母 或 兄/姊姓名*
NAME OF PARENT / SIBLING
________________
畢業年份/現讀班級*
YEAR OF GRADUATION/
CLASS ATTENDING
_________________
2. 兄/姊在與該小學同一校址的中學部就讀
SIBLING(S) STUDYING IN THE SECONDARY SECTION IF IT IS OF THE SAME ADDRESS AS THE PRIMARY SCHOOL
(二十分)
(20 POINTS)
3. 父/母為該小學的校董
PARENT(S) BEING A SCHOOL MANAGER OF THE PRIMARY SCHOOL
(二十分)
(20 POINTS)
4. 父/母或兄/姊為該小學的畢業生
PARENT(S) OR SIBLING(S) BEING A GRADUATE OF THE PRIMARY SCHOOL
(十分)
(10 POINTS)
5. 首名出生子女 (即為家庭各子女中最年長者)
FIRST - BORN CHILD (THE ELDEST CHILD IN THE FAMILY IRRESPECTIVE OF SEX)
(五分)
(5 POINTS)
6. 與該校的辦學團體有相同的宗教信仰
SAME RELIGIOUS AFFILIATION AS THE SPONSORING BODY WHICH OPERATES THE PRIMARY SCHOOL
(五分)
(5 POINTS)
7. 父/母為該小學主辦社團的成員 18
PARENT(S) BEING A MEMBER OF THE SAME ORGANISATION WHICH SPONSORS THE OPERATION OF THE PRIMARY SCHOOL
(五分)
(5 POINTS)
本人有超過一名子女在自行分配學位階段向同一間小學申請
I HAVE MORE THAN ONE CHILD APPLYING FOR DISCRETIONARY PLACES IN THE SAME PRIMARY SCHOOL.
其小一入學申請編號(如有)及姓名是：
THE POA APPLICATION NUMBER(S) (IF ANY) AND NAME(S) IS / ARE : _________________________________________________________________________
19 是 YES
注意：如需列印/影印此申請表使用，必須將第一及第二頁作雙面列印/影印
Note: If you would have to use printed/photocopied application form, please ensure P.1 and P.2 are printed/photocopied on the same sheet (i.e. double-sided printing).
C
校印
SCHOOL CHOP
POA113 (Rev. 7/22) Downloadable version 請翻後頁 Please Turn Over
2
1. 本人謹作以下聲明:(i) 本人為上述申請兒童的家長 / 監護人*；及
(ii) 此表格內的資料全屬正確無訛。倘若有虛報資料，本申請將會作廢及 申請兒童獲派的學位將會被取消。
2. 本人明白教育局會在有需要時採取適當的行動，查核此申請表內所提供的 資料，及/或有關此申請所提供的資料的真確性。教育局亦可能因此而要求 本人面見並提供任何相關的文件和資料，及/或作出宣誓。本人明白，如有 需要，教育局亦可能會進行家訪，查核此申請表內所提供的，及/或與此申 請有關的資料的真確性。本人亦明白，若教育局在合理及有需要的情況下 作出上述要求，以證實此申請表內，及/或有關此申請所提供的資料的準確 性和真確性，而本人又未有向教育局提供此等協助及/或資料，教育局則會 就本人的申請採取相應行動，其中包括暫緩處理有關的申請。
3. 本人同意教育局聯絡有關人士、公司、機構或政府部門，向他們透露在此 申請表內，及/或與此申請有關的個人資料，以核實此申請表內，及/或與此 申請有關的資料的真確性及作學位分配事宜和其他與教育有關的用途，本 人亦同意任何人士、公司、機構或政府部門為此向教育局透露本人的個人 資料。
4. 本人已明白印於本頁下半部份關於在此表格提供的個人資料的用途，和有 關查閱及改正資料的權利。
5. 本人確知只能為申請兒童向一間官立或資助小學申請學校自行分配的學 位。倘若同時申請多間官立或資助小學，則本申請將會作廢及申請兒童將 不獲分派自行分配學位。
6. 本人已明白申請兒童如獲直接資助計劃 (直資) 小學取錄，在接受直資學 校小一學位後，將不能透過小一入學統籌辦法獲派小一學位。如他/她已透 過小一入學統籌辦法獲派學位，該學位亦會被取消。
7. 本人已明白申請兒童若已獲私立小學取錄而仍然繼續參加小一入學統籌辦 法，其名字將會在統一派位結果公布前送交有關小學參考。
*請將不適用者刪去
1. I declare that:
(i) I am the parent/guardian* of the aforementioned applicant child; and
(ii) To the best of my knowledge and belief, the information contained in this form is true and correct. If false information is provided, this application will be rendered null and void and the Primary 1 place allocated on the basis of this application will be withdrawn.
2. I understand that the Education Bureau (EDB) will take measures as they consider necessary and appropriate to verify the information provided in and/or in relation to this application and I may be required to attend interview and provide EDB with any document and information and/or to make any sworn declaration for such purpose. I understand that EDB may also conduct home visits to verify the information provided in and/or in relation to this application as and when necessary. I understand that if EDB is not provided with such assistance and/or information as reasonably necessary to satisfy it as to the accuracy and truthfulness of the information provided in and/or in relation to this application, EDB will take any necessary action in relation to my application, including holding it in abeyance.
3. I give consent to EDB to disclose the personal data provided in and/or in relation to this application to, and to liaise with, any person, company, organisation or government department/bureau concerned for the purpose of verifying the information provided in and/or in relation to this application, school places allocation and other education-related purposes. I also give consent to any person, company, organisation or government department/bureau to release my personal data to EDB for any of such purposes.
4. I understand the purposes for which the personal data provided by means of this form will be used, as well as my rights for data access/correction as printed below on this page.
5. I understand that I may apply for a discretionary place for the applicant child in only ONE government or aided primary school. I also understand that if multiple applications are made, this application will be rendered null and void and any discretionary place offered on the basis of this application will be withdrawn.
6. I understand that if the aforementioned applicant child has accepted the offer of a Primary 1 place in a Direct Subsidy Scheme primary school, he/she will not be allocated a Primary 1 place through the Primary One Admission System. If a school place has been allocated to him/her through the Primary One Admission System, that school place will be withdrawn.
7. I understand that if the aforementioned applicant child has been offered a Primary 1 place by a private primary school and yet opted to remain in the Primary One Admission System, his/her name will be sent to the primary school concerned for information prior to the release of results of Central Allocation.
* Delete whichever is inappropriate
日期 家長或監護人簽署
Date:__________________________________________ Signature of parent/guardian:______________________________________
家長請注意 Notice to Parents
(1) 你在此表格所提供的個人資料，將用於核實此申請表內，及/或與此申請有關的資料的真確性或作學位分配事宜及其他與教育有關的用途。獲得「自 行分配學位」的申請兒童姓名將在有關的學校張貼。
The personal data provided by means of this form will be used for verifying the information provided in and/or in relation to this application, school places allocation and other education-related purposes. Names of successful applicant children for the discretionary places admission will be posted up at the schools concerned.
(2) 本局可能將收集所得的個人資料向任何有關人士、公司、機構或政府部門及你的子女獲派/轉讀的學校披露，以作任何上述第(1)段所述的用途。
The personal data collected may also be disclosed to any person, company, organization or government department/bureau and the school to which your child is allocated/transferred for any of the purposes mentioned in paragraph (1) above.
(3) 你必須在此表格提供所需的個人資料。倘若所提供的資料不充足，教育局可能無法辦理有關申請。
The provision of the personal data by means of this form is obligatory. If you do not provide sufficient information, the Education Bureau may not be able to process your application.
(4) 根據《個人資料（私隱）條例》第 18 和 22 條及附表 1 第 6 原則的規定，你有權更改或查詢所提供的個人資料。
You have the right of access and correction with respect to the personal data as provided for in Sections 18 and 22 and Principle 6 of Schedule 1 of the Personal Data (Privacy) Ordinance.
(5) 任何與所收集的個人資料有關的查詢，包括要求查閱和改正資料，應提交：
Enquiries concerning the personal data collected, including the making of access and corrections, should be addressed to:
九龍觀塘 偉業街 223 號
宏利金融中心 2 樓 2 室 教育局學位分配組 高級教育主任
Senior Education Officer,
School Places Allocation Section, Education Bureau Office 2, 2/F,
Manulife Financial Centre, 223 Wai Yip Street, Kwun Tong, Kowloon.
(6) 根據刑事條例（香港法例第 200 章），任何人製造虛假文書，意圖由其本人或他人藉使用該文書而誘使另一人接受該文書為真文書，並因接受該文 書為真文書而作出或不作某些作為，以致對該另一人不利，則該名首述的人即犯偽造的罪行，一經循公訴程序定罪，可處監禁 14 年。
A person who makes a false instrument, with the intention that he/she or another shall use it to induce somebody to accept it as genuine, and by reason of so accepting it to do or not to do some act to his/her own or any other person’s prejudice, commits the offence of forgery and is liable on conviction on indictment to imprisonment for 14 years under the Crimes Ordinance, Cap. 200 Laws of Hong Kong.
(7) 有關小一入學一般查詢，可致電 2832 7700 與教育局學位分配組聯絡。
For enquiries concerning Primary One Admission, please contact the School Places Allocation Section of the Education Bureau at 2832 7700.
注意：如需列印/影印此申請表使用，必須將第一及第二頁作雙面列印/影印
Note: If you would have to use printed/photocopied application form, please ensure P.1 and P.2 are printed/photocopied on the same sheet (i.e. double-sided printing).
POA113 (Rev. 7/22) Downloadable version
