The University of Hong Kong
HKU 81 Inclusion Fund
Application Form
Please make sure you have read the Application Guidelines before completing the following
form in BLOCK letters.
Nature of Proposed Project:
 Grant for Voluntary Service Project
 Grant for Research
 Grant for Publication
 Grant for Public Education Programme
 Grant for other learning activity (e.g. events, seminars)
 Others, please specify: _______________________
(A) Personal Data
1. Project Coordinator
Title: Prof./Dr./Mr./Mrs./Miss*
Surname in English: _____________________________________
Given name in English: _____________________________________
Name in Chinese (if applicable): _____________________________________________
Date of birth (dd/mm/yyyy): _______________________________________
University / Staff Number*: ______________ Faculty: ___________________________
Current post (staff only): ____________________________________________________
Curriculum/ year of study (student only): ___________________
Intended date of completion of studies (student only) (mm/yyyy): _________________
Daytime contact no.:
Mobile no.:____________________
Email address: ___________________________________________________________
Correspondence address: ____________________________________________________
Other Project Team Members (if applicable)
Name
Faculty/Department Current post
University/
Staff
number
Mobile
number
Email address
* Delete as appropriate
1
(B) Project information
1.
Project title:
2.
Total amount of funding applied for (HK$):
3.
Other sources of funding? □ Yes
□ No
□ Application in progress
If yes/application in progress, please provide details (including funding source and
amount)
4.
Name of Project Advisor (if any) :
5.
Project summary (word limit: 500 words)
6.
Expected project start date: _______________________________________
7.
Expected project completion date:__________________________________
(C) Declaration
1.
I have read the HKU 81 Inclusion Fund Application Guidelines
2.
I am aware that due acknowledgement of the Fund must be included in all publicity materials, reports
and outputs of the project
3.
I am aware that the project team must submit at least ONE PHOTO of project activities with the final
report
4.
I am aware that all changes to approved projects and deferral of completion date require the approval of
the Steering Committee in advance.
5.
I am aware that I must disclose any other income source used to finance the project or risk the withdrawal
of approved funding from the HKU 81 Inclusion Fund.
6.
I confirm to the best of my knowledge that all information provided in this application is accurate.
Signature of project coordinator: _______________________________________
Full name of project coordinator: _______________________________________
Date: ___________________________
Remark: Completed application form together with the project proposal (in English only) and other
relevant materials should be sent to the Counselling and Person Enrichment Section, Centre of
Development and Resources for Students (CEDARS) via email at cedars-cope@hku.hk on or before
24th February 2016. You will be notified of the application result by the end of April 2016 via email.
21st January 2016