CUHK Seed Funding for

Clinton Global Initiative University (CGI U) Meeting & Commitment to Action

APPLICATION FORM

Section One – Personal Information

Name:
Student ID:
Academic Program:
College (if applicable):
Expected Graduation Term/Date:
Campus Email:
Other Email:
Phone Number:

I am applying as a(n) individual/ group (please circle the appropriate).

Personal Information of other member(s)

Name:
Student ID:
Academic Program:
College (if applicable):
Expected Graduation Term/Date:

* * * * * * * * * * * *

Name:
Student ID:
Academic Program:
College (if applicable):
Expected Graduation Term/Date:

Section Two – Commitment Information

Commitment name:
Commitment focus area:
/ £  Education
£  Environment and Climate Change
£  Poverty Alleviation
£  Peace and Human Rights
£  Public Health
Primary keyword:
Secondary keyword:
Location where Commitment takes place (City, State, Region or Country):
Expected completion date:

1.  In the third person, write a short summary of your commitment. (word limit:120 words)

·  In one to two sentences, specifically describe actions you and/or your group will take to implement change.

·  In one sentence, describe how the actions you and/or your group take will impact a specific global or local challenge.

·  Include strategic external partners you and/or your group will work with.

·  Explain the outcomes you and/or your group expect to see as a result of your commitment.

2.  CGI U students work to address specific global challenges. What issue are you trying to solve through your commitment. (word limit: 150) (If you reference statistics or facts, please cite your source(s).)

·  What is the problem or issue you and/or your group are working to address?

·  What is your target population?

·  What challenges do you/or your group anticipate encountering?

3.  In this section, we want to understand how your commitment is specific and attainable. (word limit: 250)

·  Define the goals of your Commitment to Action.

·  Describe the activities you and/or your group will undertake to carry out your Commitment to Action.

·  If appropriate, list any external partners.

·  Include a timeline for proposed activities.

4.  How is your commitment new and different from other initiatives that are attempting to tackle a similar problem? (word limit: 150)

·  How do you and/or your group plan to collaborate with, develop partners with, or learn from those with comparable projects?

·  If you have applied to CGI U with this commitment in the past, how have you expanded your project – either through geographic scope, focusing on a different approach, or working with new partners?

5.  In this section, we want to know how your commitment is measureable. (word limit: 150)

·  What benchmarks will you put in place to measure progress towards your expected outcomes?

·  Define your goals, both short- and long-term.

·  Identify specific data and results you will analyze, interpret, and report out on as you make progress toward achieving your goals.

Additional Comments

Notes to applicants

1.  Applicants are required to submit the completed application form, together with a budget plan, a video presentation and a letter of support (as per point 3 of Eligibility in the application guidelines) to Miss Eunice So at / Office of Student Affairs, 1/F Benjamin Franklin Centre, by May 10, 2017.

2.  Shortlisted groups may be invited to attend a face-to-face interview.

3.  The awarded project teams shall submit an interim report (approximately 200 words) describing the progress and outcomes of the projects by December 1, 2017. The awarded project teams shall give a presentation on their CGI U Commitment to Action in a public seminar to be held on CUHK campus and submit an evaluation report within one month upon completion of the project.

4.  The application timeline is a follows:

Application Timeline

Date / Event
March 1, 2017 / Early decision deadline for CGI U 2017 application
May 10, 2017 / Final application deadline for CGI U 2017 & CUHK Seed Funding
June, 2017 / Interview
Late June, 2017 / Results announcement on CUHK Seed Funding for project implementation
October 13-15, 2017 / Students attend the annual CGI U meeting at Northeastern University in Boston, Massachusetts, USA

Declaration

I, ______(name), declare that the statements made and information given in this application are, to the best of my knowledge, true, complete, and correct. I have read and fully understand the ‘Application Guidelines’ and the notes above. I understand that the personal data provided in this form will be used by the relevant committees and authorized personnel responsible for handing applications for the award. I also consent to sharing my contact information with members of the media by the University.

Signature of Applicant: / Date:

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