M.110/1017
UNIVERSITY OF HONG KONG
LI KA SHING FACULTY OF MEDICINE
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 GBP1,307 (in London)* or x HKD10,765 (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 / DateOctober 2017
WKL/VC/KL/es
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