<p> Universiti Tunku Abdul Rahman Form Title : APPLICATION FOR STUDENT DESIGN & RESEARCH ACTIVITIES – CONTEST PARTICIPATION Form Number : FM-IPSR-R&D-026 Rev No : 4 Effective Date: 9/8/2016 Page No : 1 of 6</p><p>PART A – PARTICULARS</p><p>Faculty Advisor :</p><p>Research Centre :</p><p>Participants’ Details</p><p>No Student Name & ID Programme Faculty/Dept H/phone No Email 1 2 3 4 5</p><p>PART B – CONTEST DETAILS</p><p>Type of Enrolment Type A (involving financial Type B (not involving financial support) support)</p><p>Title of Contest:</p><p>Date/Time: Date of Please provide explanation for submission less than 1 month before the event. Submission by Faculty/Centre: Venue:</p><p>Organiser:</p><p>Justifications for UTAR’s Involvement: Commitment from UTAR (registration Please attach detailed proposal that includes the budget and/or other fees, and/or other resources required resources) Student Selection Please explain on the student selection criteria. Criteria</p><p>Funding Amount Please attach details of the estimated expenses. Requested (RM) (for Type A only) Other parties (internal and external ) involved</p><p>Note: Application and proposal should be submitted at least 1 month before the event. Approval is subject to funding availability. Universiti Tunku Abdul Rahman Form Title : APPLICATION FOR STUDENT DESIGN & RESEARCH ACTIVITIES – CONTEST PARTICIPATION Form Number : FM-IPSR-R&D-026 Rev No : 4 Effective Date: 9/8/2016 Page No : 2 of 6</p><p>PART C – CHECKLIST </p><p>State No Checklist Yes/No 1 Is this contest related to Design or R&D? 2 Is this contest supported by faculty or a research centre of UTAR? 3 Is this contest undertaken by students of UTAR? 4 Does this contest involve at least one UTAR staff as event advisor/patron? 5 Is this contest related to the research area of a research centre in UTAR?</p><p>Outcome from previous participation in a similar event (if any) (Please provide summary of achievement in the previous event e.g. awards won, number of students/teams entered into the final round, etc.)</p><p>For IPSR Use Remarks on the outcome of : previous participation Note: Outcome report to be submitted within 1 month after participation in the contest</p><p>PART D - CERTIFICATION</p><p>I have duly completed this application form and attached the required supporting documents. I acknowledge that I will have to contribute 20% of any cash prize won in this contest to the UTAR Research Fund if my participation is with University financial sponsorship. I will adhere to all the rules & regulations of the contest.</p><p>______Applicant’s Signature Date Name:</p><p>______Faculty Advisor’s Signature Date Name: Universiti Tunku Abdul Rahman Form Title : APPLICATION FOR STUDENT DESIGN & RESEARCH ACTIVITIES – CONTEST PARTICIPATION Form Number : FM-IPSR-R&D-026 Rev No : 4 Effective Date: 9/8/2016 Page No : 3 of 6</p><p>PART E: ASSESSMENT FOR STUDENT RESEARCH ACTIVITIES - PARTICIPATION IN CONTEST</p><p>Note: To be assessed by HOD and Centre Chairperson that is relevant to this contest.</p><p>PLEASE CIRCLE THE RELEVANT SCORE POINT/RESPONSE No. Items Score Points HOD Dean/ Director 1. Relevancy of the Contest to the programme currently being pursued by the applicant/group Yes 1 1 No 0 0 2 Relevancy of the Contest to Design or R&D Yes 1 1 No 0 0 3 Relevancy of the Contest to the research centre / faculty Yes 2 2 No 1 1 4 Quality of the Contest Excellent (International level) 3 3 Good (National that leads to International level) 2 2 Average (National level) 1 1 5 Will this Contest enhance the development of team work, leadership skill, discipline and responsibility among students? Yes 1 1 No 0 0 6 Will this Contest enhance the development and design skill of the students? Yes 1 1 No 0 0 Total Score Points Comments by HOD: Comments by Dean/ Director:</p><p>A total score points of 7 based on the above criteria (1-6) is required (Please tick (√) </p><p>□ Supported □ Not Supported □ Supported □ Not Supported</p><p>______Signature of HOD Signature of Dean/Director Name: Name: Date: Date: </p><p>*If relevant to research centre: Name of Research Centre: ______□ Supported □ Not Supported</p><p>______Signature of Research Centre Chairperson Name: Date: Universiti Tunku Abdul Rahman Form Title : APPLICATION FOR STUDENT DESIGN & RESEARCH ACTIVITIES – CONTEST PARTICIPATION Form Number : FM-IPSR-R&D-026 Rev No : 4 Effective Date: 9/8/2016 Page No : 4 of 6</p><p>PART F. FACULTY RECOMMENDATIONS TYPE A: RECOMMENDATION FROM FRDPC ( ) Recommended ( ) Not Recommended </p><p>Amount Recommended : Meeting Date : FRDPC Minutes :</p><p>Signature: Date:</p><p>TYPE: A RECOMMENDATION FROM FBO TYPE: B RECOMMENDATION FROM DEAN ( ) Recommended ( ) Recommended ( ) Not Recommended ( ) Not Recommended Amount Recommended : Meeting Date : FBO Minutes : </p><p>Signature: Signature: Date: Date:</p><p>PART G. VERIFICATION VERIFICATION FROM IPSR Account status as at : Amount approved : Amount utilised : Balance : Sufficient Fund Insufficient Fund</p><p>Signature : Name : Date : </p><p>PART H. Approval (Funding of less than RM10,000.00 / event not involving fiinancial commitment)</p><p>Type A: APPROVAL FROM VP (RDC) Type B : APPROVAL FROM VP (RDC) (Provision of Funding less than RM10,000.00) (not involving financial commitment )</p><p>( ) Approved ( ) Approved ( ) Not Approved ( ) Not Approved </p><p>Amount Approved:</p><p>Signature : Signature : Date : Date : Universiti Tunku Abdul Rahman Form Title : APPLICATION FOR STUDENT DESIGN & RESEARCH ACTIVITIES – CONTEST PARTICIPATION Form Number : FM-IPSR-R&D-026 Rev No : 4 Effective Date: 9/8/2016 Page No : 5 of 6</p><p>PART I. RECOMMENDATION (Funding of more than RM10,000.00) RECOMMENDATION FROM RDCC ( ) Recommended ( ) Not Recommended </p><p>Amount Recommended : Meeting Date : RDCC Minutes :</p><p>Signature : Name : Date : </p><p>PART J. APPROVAL Type A: APPROVAL FROM SMC ( ) Approved ( ) Not Approved Amount Approved: Meeting Date : SMC Minutes :</p><p>Signature : Date :</p><p>PART K. ASSESSMENT AFTER PARTICIPATION IN CONTEST Note: To be assessed by IPSR.</p><p>(This section is to be filled in within 1 month after students’ participation in the contest) Score Points No. Items IPSR 1. Type of Participation International 3 National 1 2. Award/Recognition Won 1st Prize 5 2nd Prize 4 3rd Prize 3 Consolation Prize/Others (For others, please indicate): 2 </p><p>No award won 0 3. Has this Contest enhanced the development of teamwork, leadership skill, discipline and responsibility among the students? Yes 1 No 0 6. Has this Contest enhanced the development and design skill of the students? Yes 1 No 0 Total Score Points /10 Remarks Universiti Tunku Abdul Rahman Form Title : APPLICATION FOR STUDENT DESIGN & RESEARCH ACTIVITIES – CONTEST PARTICIPATION Form Number : FM-IPSR-R&D-026 Rev No : 4 Effective Date: 9/8/2016 Page No : 6 of 6</p><p>L. OVERALL ACHIEVEMENT IN CONTEST (Please tick (√) </p><p>8 – 10 Excellent 6 – 7 Good 4 – 5 Fair ≤ 3 Needs Improvement</p><p>*Note: Please take note that this assessment serves as a record of outcome from the participation in design & research activities and as recognition for staff/students’ involvement in such activities.</p>