*For PolyU Alumni Only

COMP ALUMNI SCHOLARSHIPAPPLICATION FORM

Personal Data

Full Name: Student No.:

Programme Title: Code:

Contact Tel. No.: (852) Email (Non-PolyU account):

Undergraduate Study Qualification

Please attach a copy of your PolyU transcript

UG Programme Title in PolyU:
UG PolyU Student ID No.: / Department:
PolyU Award Title: / Year Graduated:
Working Experience (if applicable)
Current Employer:
Position held: / Duration of Employment:
Job Duties:
Declaration

I, (name of applicant),

-declare this application has my consent and the information given by me in this form is complete and true to the best of my knowledge;

-note my disciplinary record(s) with PolyU (if any) may be taken into consideration in the processing of this application;

-note this application is no longer eligible if I withdraw my studies from PolyU after being nominated; and

-am aware I am required to attend any related function/ceremony hosted by PolyU/the donor (if any) and may be invited to join other activities/programmes organized by PolyU/the donor.

I agree to the handling of my information and personal date provided as follows:

-my provision of all the personal data requested in this form is obligatory and failure to provide these data and the required documents (if any) may affect the processing and outcome of this application;

-the personal data/information provided in this form will be used by the Office of Student Resources and Residential Life (SRRL) and my Faculty/Academic Department for activities relating to 1) handling and assessment of this application, 2) conduction of survey(s) for service improvement and 3) publicity or publication (if I have been selected for the Scholarship);

-SRRL will verify my personal data with the relevant department(s) in PolyU and disclose the personal data provided to those relevant parties 1) for the above-mentioned purposes, 2) where I have given my consent to such disclosure, and 3) where such disclosure is authorized or required by law;

-The personal data/information provided will be kept for a period of no more than four years under normal circumstances, or within one year upon my graduation/departure from PolyU;

-I have the right to access and correct the personal data provided by me in this application form. If I wish to access my personal data provided in this nomination, I can submit a request via the “Data Access Request Form” which is obtainable from theAcademic Secretariat Service Centre at M101, PolyU. A handling fee will be charged.

-this application form and the related documents submitted are not returnable.

Signature of ApplicantDate

Note:The scholarship will be 15% of the tuition fee of the subjects taken in the first year of study (including summer term). To qualify, the awardee will be required to maintain a cumulative GPA of 3.0 or above. Applicants are required to pay the full tuition fee to register for the first-year courses. Successful applicants will be reimbursed an amount equivalent to the scholarship at the end of the first year.

Recommendations from Department

I am satisfied this Student (name of Applicant) has met the eligibility ofthe Scholarship, and has already fulfilled all the selection criteria.

Endorsed by

Signature Signature

Name of MSc Programme Scheme Leader Head of Computing

Date Date

1