The Hong Kong University of Science & Technology

Application Form for HKUST AEFStudent Start-up Grants

2016/17 Academic Year

Note:Please return the completed and signed application form, together with copies of appendices andsupporting documents, to Ms. Jerri Ng, Development and Alumni Office, Room 3008, Academic Building, HKUST.
The application form must be typed clearly and neatly.Applications by e-mail/fax and applicationswith missing supporting documents will NOT be considered.
For inquiries, please contact Ms Jerri Ng at .

PART IPersonal Particulars

(* please delete as appropriate)

Full Name (English): / Name in Chinese (if any) :
(Surname, First Name)
Gender: / Male/Female* / Student type: / Local / Non-local*
Student ID: / Year of Study in 2016/17:
Department: / Program:
Contact No.:
(Home) / (Mobile)
Email Address:
(HKUST) / (Personal)

PART II Business Information

Business Name:
Industry:
Date of Incorporation:
Website (if any)
Stakeholders
Partners (if any):
Name / Role / Contact Tel / Contact Email / UST Affiliation*
No/student/staff/alumni
No/student/staff/alumni

(* Please delete as appropriate and list any additional partners in a separate attachment)

PART IIIBusiness Details#

Please write a short summary of your business and include the following:

- Description of your business and its potential impact

- The role of you and your partners in the business; and your team’s relevant experience, expertise and skills

- Your business model: market, customers, strategies, possible hurdles and proposed solutions

- Why you need the sponsorship and your budget estimation

- Any additional information for the selection panel’s consideration

# Please enclose supplementary information such as certificates of awards / participation, Business Registration Certificates,etc. and mark as Appendices.

PART VI Applicant’sDeclaration

I certify that:

  1. The particulars provided in this application formare true and correct. In the event that any information is found to be false or incorrect, I understand that my application will not be considered.
  2. I also understand that if the information provided in support of this application is found to be false or incorrect AFTER the award is bestowed on me,I undertake to forfeit and refund the award amount which has been released to me in full to the University.

Signature: / Date:

------

The personal information provided in this application form will be used for eligibility verification of the awardapplicantand compilation of statistical data purposes.

1