Community College of City University

Scheme for Subsidy on Exchange for Post-secondary Students (SSE / SSEBR)

Application Form

Part I:Personal Particulars

Name : (in English) / (in Chinese)
(As shown on your HKID card)
HKID no. : / Student ID no. :
Mobile Phone no. : / EID : / @my.cityu.edu.hk
Programme Name :
Cohort : / Cumulative GPA :

Part II:Applicant's Financial Conditions

Applicant MUST be in receipt of means-tested student financial assistance from Student Finance Office (SFO) of the Working Family and Student Financial Assistance Agency (WFSFAA) or whose families are in receipt of the Comprehensive Social Security Assistance (CSSA).

Yes / No / Received or to be Received Date / Amount ($)
Grants from Working Family and Student Financial Assistance Agency (WFSFAA) /  /  / If yes, please specify :
Recipients of Comprehensive Social Security Assistance (CSSA) /  /  / If yes, please specify :
Other Scholarships / Sponsorships / Subsidy Schemes /  /  / If yes, please specify :
Please specify :

Part III:Outbound Exchange Programme

The maximum amount of subsidy varies according to the destination and duration of the exchange activity. The duration should ONLY cover the period from the commencement date to the completion date of the official exchange programme. Travelling time back and forth between Hong Kong and the exchange destination should NOT be counted.

Application for Subsidy Scheme : / Scheme for Subsidy on Exchange for Post-secondary Student (SSE)
Scheme for Subsidy on Exchange to “Belt and Road” Regions for Post-secondary Student (SSEBR)
 1st time 2nd time(please specify the country last visited : )
Name of Exchange Programme :
 Credit-bearing Award-bearing
Destination : / Country in “Belt and Road” Regions : /  Yes No
Name of Institution :
Duration of Programme: / From / To / ( Days)
Type : /  Study relating to the fields of studies /  Language immersion programme
 Cultural study /  General study
 Others, please specify :
Objectives :
Content:
Benefit to the Participant :

Part IV:Declaration and Consent

  1. I declare that the information provided above is true and accurate. I understand that any inaccurate information will render thisapplication invalid. Any Subsidy approved will be withheld and any payment made must be refunded to CCCU.
  2. I understand I am only eligible
  1. forthe subsidy under the SSE once during my studies at CCCU or my previous studies in programme(s) at sub-degree level in Hong Kong.
  2. for the subsidy under the SSEBR twice at most, each for a different destination in terms of country/economy, during my studies at CCCU or my previous studies in programme(s) at sub-degree level in Hong Kong.
  1. I understand that the destination of exchange programmes subsidized under the SSEBR must be different from the destination of the programme subsidized by SSE in terms of country/economy, if any.
  2. Uponsuccessful application, I undertake to submit a reflection report to CCCU on the activities participated and the learning experiences and benefits acquired within one monthafter returning Hong Kong. The reflection report would be endorsed by Programme Leader/authorized person of the institution and used by Education Bureau for publicity and sharing purposes.
  3. I agree that my personal data provided in this application form will be used by CCCU, WFSFAA and related government bureaux/ departments to assess my eligibility for the Subsidy Schemesand for other related purposes. I also agree that the information provided in this form and subsequent submissions may be publicized by CCCU, WFSFAA and related government bureaux/ departments if necessary.
  4. Under the Personal Data (Privacy) Ordinance, I understand that I have a right to request access to, and to request correction of, my personal data in relation to my application.

Signature of Applicant / Date

Checklist on document copies to be submitted with the completed form:

Applicant’s Student ID card and HKID card (please copy them in 1 page for environmental reason)

Confirmation letter / Proof of acceptance of the outbound exchange programme

The latest Notification of Result of Application for Financial Assistance from WFSFAA

Documentary proofs from the Social Welfare Department for family member(s) who is/are receiving Comprehensive Social Security Assistance, including the Certificate of CSSA Recipients (for Medical Waivers) and notification letter

Other related documentary proof for verification

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