PolyU International Competition and Conference Participation Scheme

Application Form –Individual Applicant

Please read application guidelines carefully and submit your completed application form with supporting documents to International Affairs Office by email to .

A.Personal Data

First name: / Last name:
Student ID no.: / Gender:
Department:
Faculty / School:
Programme of study:
Year of study:
Latest GPA:
Expected month/year of graduation:
Tel. no.(Mobile):
Email:
Reason(s) for attending the competition / conference :
How would you benefit from attending the competition/conference:

B.About the Competition/Conference

Name of competition/conference:
Date and Time:
Venue (please indicate city and country):
Organizer:
Description of the competition / conference:
(nature, purpose,scale, target audience, etc)

C.Comment and Endorsement by PolyU Department

Comment
Do you think the competition / conference can benefit the applicant’s personal / professional / academic development?
Yes
No
Othe comments about the competition /conference, or the applicant’s participation in it:
Endorsement of the applicant’s participation in the competition / conference
Name:
Post:
Department:
Signature:
Date:

Note: Applicants normally shall obtain endorsement from the heads of their academic departments or their programme leaders. Endorsement from PolyU administrative departments is also recognized, if applicable.

D.Estimated Expenses and Subsidy

Estimated expenses
(a)Participation fee: / HK$ / Other currency:
(b)Flight: / HK$
Destination:
(c)Accommodation: / HK$
Total (a) + (b) + (c): / HK$
Subsidy
Amount of subsidyapplied for:
(should be no more than 2/3 of total expenses ) / HK$
Do you apply for bursaries to cover the remaining 1/3 of expenses should your application be successful? / Yes
(Please attach a copy of confirmation letter from Student Finance Office (SFO) of Working Family and Student Financial Assistance Agency, HKSAR Government, if you are recipient of any grant administered by SFO.
No
Other source of funding
Did you apply for funding for the same activity from other source(s) / Yes
No
If yes, please state:
(1)the amount of subsidy approved by other source(s) / under application: / HK$
Other currency, if applicable:
(2)source(s) of funding:
  1. Request for Advanced Subsidies / Bursaries

Please put down “N/A” if advanced funding is not required.

Amount of advanced subsidy/ bursaryrequested: / HK$
Date to receive advanced subsidy/bursary:
Justifications for the need of advanced subsidy/ bursary:
  1. Declaration

I have read and understand the Application Guidelines. The information given by me in this form is accurate and original to the best of my knowledge.

I also authorize the International Affairs Office (IAO) to handle and use the personal data/information provided by me and any supplementary information as required by IAO for activities relating to the handling and assessment of this application. I understand the above personal data/information will be kept for a period of no more than four years under normal circumstances.

I also give my consent to PolyU to share the information in this application (name, year of study, programme of study, competition/conference attended)with the PolyU community and general public, and to use it for publicity purpose should our application be approved.

I understand I have the right to obtain access and make correction to the personal data provided by me in this application form. I am aware that I have to pay notional charges for making copies of this application form. Such request should be addressed to the Interim Director of International Affairs of PolyU in writing. I also understand this application form and the related documents submitted are not returnable.

Signature of applicant / Date
Name in block letters
  1. Supporting documents to be submitted with this application

Copy of PolyU student ID of applicant

Copy of latest transcripts of applicant

Supplementary information about the organizer, and competition/conference (e.g. programme)

Copy of confirmation letter from Student Finance Office (SFO) of Working Family and Student Financial Assistance Agency, HKSAR Government, if you are recipient of any grant administered by SFO.