The Hong Kong University of Science and Technology s1

The Hong Kong University of Science and Technology Student Affairs Office

Hsin Chong - K.N. Godfrey Yeh Education Fund Award for Study / Research Projects & Exchange Programs 2015/2016

APPLICATION FORM

Notes for Applicant: 1. Complete either Part I or II, and Parts III, IV and V. 2. The completed application form should be submitted to the Student Service Counter in Student Lounge on G/F (near lift no. 4) not later than 30 April 2016 3. For enquiries, please contact Student Support & Activities Team at [email protected]

Name of Proposed Program: Part I (to be completed by individual applicant only) Name of applicant: Student No. Program of Study: Year of Study: Correspondence Address:

Contact Phone No. ITSC Email: Previous Travel Experience outside Hong Kong:

Part II (to be completed by group application only) Name of Group (if any): Name of Group Leader: Student No. Program of Study: Year of Study: Correspondence Address:

Contact Phone No. ITSC Email: No. of Participants in the Group: Particulars of Group Organizers and/or Members including the group leader (please use separate sheet if necessary): Name Department Year of Study Part III Proposed Program (Please attach with a detailed proposal, if necessary) Places to be visited (the planned routing, itinerary including dates, means of transportation and reason for selecting these places):

Objectives of the program:

Program content and methods in achieving the objectives:

How will participants benefit from the program?

A description of preparation work done so far:

For applications with more than one participant, please state methods used in the selection of participants: Part IV Budget for the Program Expenditure Item Amount (HK$)

Total:

Income Total amount expected from this Award:

Contribution by Participants: each (in total) Other subsidy/source: (Any other subsidy under application should be included herewith)

Total:

Part IV Declaration

I hereby declare that the information provided on this form is true and accurate. I will inform SAO whenever differences arise after the submission of the form. I understand that information provided in this application form will be used for assessment for “Hsin Chong - K.N. Godfrey Yeh Education Fund Award for Study / Research Projects and Exchange Programme 2015/2016 and will be forwarded to the donor.

Signature of Applicant/Group Leader: Date: