UNIVERSITY OF HONG KONG - HKU Li Ka Shing Faculty of …
M.127/419
Application for University of Hong Kong/China Medical Board Grant
A. Personal Particulars
|1. Name: | |
|2. Department: | |
|3. Tel: | |Email: | |
|4. Post: | |
|5. First date of appointment as an academic staff/senior research staff (i.e. Research |
|Officer or above) at HKU: | |
|6. End date of the current contract (for Research Assistant Professor, Research Officer |
| |and Post-doctoral Fellow only) at HKU: | |
7. Please provide a brief curriculum vitae covering the following items:
(a) Appointments held (University and elsewhere);
(b) Higher degrees and/or specialist qualifications obtained, with dates of award;
(c) Previous overseas training, including details of scholarships or awards received in the past 10 years;
d) Research interest; and
e) Most representative publications.
B. Proposal
8. (a) Overseas institution(s) concerned with postal address [please attach written agreement obtained from these overseas institution(s)]:
| |
(b) Person(s) with whom you will be working, including his/her designation in the overseas institution(s):
| |
9. Details of the training and visit programme:
| |
10. (a) How will your proposal above enhance the role of the Medical Faculty/University as a regional centre for medical training in Southeast Asia?
| |
(b) What kind of new expertise will you bring back after the proposed training?
| |
11. Proposed dates of training, and dates of long leave, study leave, special leave, if already approved/applied:
| |
12. Total budget requested for the entire training period:
|( One round-trip airfare at economy class [the most economical fare] |HKD | |
| |
|( Maintenance allowance for | |months | | |
| x GBP1,331 (in London)* or x HKD11,150 (elsewhere)* |HKD | |
| |
|( Research supplies and equipment (up to a maximum of HKD9,000) | | |
|– please specify the items as follows: | | |
| |
|i. |HKD | | | |
|ii. |HKD | | | |
|iii. |HKD | | | |
|iv. |HKD | | | |
|v. |HKD | |HKD | |
| |
|( Conference expenses (if applicable) |
|(Note: The coverage will be in line with the University’s Conference Support for Teaching Staff scheme. Accommodation allowances |
|for attending conferences overseas shall be calculated at 60% of the subsistence allowances outside Hong Kong [available at: HKU |
|Portal > Manager Self Service > Finance & Enterprises Office > FEO Intranet Homepage > Staff > Other Financial Information > Rates |
|of Subsistence Allowance for Duty Trips Outside Hong Kong]) |
| |
|Title: | |
|Duration: | |
|Venue: | |
|Expenses: |
|i. |HKD | | | |
|ii. |HKD | | | |
|iii. |HKD | |HKD | |
|Total: |HKD | |
|Signature: | |
|Date: | |
* Please delete as appropriate.
C. Recommendation from Supervisor (to be completed by the Supervisor of the applicant who is in the grade of Research Officer or Post-doctoral Fellow ONLY)
|13. I support/do not support* the application. |
14. Please give details of the new knowledge/expertise that the applicant is expected to bring to your Department after the proposed training.
| |
15. Please indicate whether you plan to appoint the applicant in your Department after the completion of his/her current contract.
| |
| | | | | |
|Supervisor | |Name | |Date |
* Please delete as appropriate.
D. Endorsement by Head of Department
16. Recommendation:
| |
| | | |
|Head of Department | |Date |
April 2019
MSYH/VY/es
C:\CMB Grant\General\CMB Grants Form 26.doc\1-5
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