1、聯合書院邁進地球村系列United College Globe-Oriented Active Learning (GOAL) Programme 申請表 Application Form I. 申請類別 (按旅程性質) Application Type (According to Nature of the Trip) 邁進地球村系列外地實習/研究計劃 2018-2019GOAL Programme Non-local Internship/Research Scheme本計劃歡迎將參與所屬學系/學院在暑假或寒假主辦的短期外地實習及研究計劃(包括考察活動)的同學申請。This award s
2、cheme is open for application to those students who are going to join a short-term non-local internship or research programme (including field trips) of respective teaching department during summer or winter break. 邁進地球村系列進修獎 2018-2019GOAL Programme Studentships此項進修獎鼓勵同學參與由書院、大學及具信譽校外團體舉辦的短期非本地的學習計劃
3、及活動。歡迎有興趣同學申請。These studentships allow students to participate in short-term non-local study programmes and activities organized by the College, the University and other reputable outside organizations. Interested students are welcome to apply. II. 旅程時段 Time of Trip截止申請 Application Deadline 2018 年 4
4、-8 月 May-August 2018 31/3/ 2018 2018 年 12 月- 2019 年 1 月 December 2018 - January 2019 15/11/ 2018 其他 Others _ 請說明 Please specify 兩月前 Two months before departure註 : 書院或將於 2018 年 4-5 月面見參與暑假旅程的同學以作甄選。 N.B.: Interviews may be taken in April-May 2018 for applicants joining summer trips.III. 個人資料 Personal
5、 Particulars姓名(中文): Name (English) : 學院 Faculty: 系別 Dept: 年級 Year: 學生證號碼 SID: 地址 Address: 住所電話 Home Tel: 手提電話 Mobile Phone: 電郵 Email: 宿舍 Hostel(如適用 If any) 房號 Room No.: 電話 Tel: 銀行名稱 Name of Bank for Award Transaction (if approved)： 銀行戶口號碼 Bank Account No.: 身份 Status： 本地生 Local Student 非本地生 Non-local
6、 Student (A 中國內地 Mainland China, B 外地 other places)入學途徑Admission Channel請 Please UA Undergraduate student admitted via EASUJ Undergraduate student admitted via JUPASUN Undergraduate student admitted via Non-JUPAS channelsU Undergraduate student (other Channel: )P.1IV. 旅程計劃 Programme of the Trip活動名稱
7、Activity Name: 主辦單位名稱 Organizer Name: 校內 Internal 校外 External 日期 Date of Trip: 目的地國家 Country: 城市 City: 活動性質及目的 Activity Nature & Aim： 估計支出 Estimated Expenses：$ (請附上有關活動資料文件副本 Please provide copy of related information)有否獲其他資助 Financial Support Received from other Sources 沒有 No 有 Yes $_ 資助來源 Source:_
8、擬申請獎勵額 Award Amount Applied for: 曾 否 到 訪 外 地 Places Visited Before: 無 No 有 Yes,國 家 Country: 城市 City: 申請人若希望書院考慮其經濟狀況，請簡述並提供文件証明。Please provide information for the College to consider your financial situation, if preferred. 申請人簽署 Signature of Applicant: 日期 Date: On accepting this offer, please note t
9、hat you will not be eligible for consideration of other GOAL programmes of the College in this year (between 1 September 2018 and 31 August 2019)For Office Use only Application Received on: Amount Approved: Not Approved:Report & Receipts Received on: Bank Transaction Date:Personal Information Collec
10、tion StatementThe personal data provided on this Form will be used by the Dean of Students Office of United College, CUHK, for the purpose of processing student affairs matters. Data collected from or generated by students during their studies at United College may be held by/transferred to any depa
11、rtment/administrative unit within CUHK as management information to facilitate verification, communication, operation and planning. For correction of or access to the personal data, please contact the Dean of Students Office, United College.P. 2聯合書院邁進地球村系列United College Globe-Oriented Active Learnin
12、g (GOAL) Programme申請類別 (按旅程性質) Application Type (According to Nature of the Trip) 邁進地球村系列外地實習/研究計劃 2018-2019GOAL Programme Non-local Internship/Research Scheme本計劃歡迎將參與所屬學系/學院在暑假或寒假主辦的短期外地實習及研究計劃(包括考察活動)的同學申請。This award scheme is open for application to those students who are going to join a short-te
13、rm non-local internship or research programme (including field trips) of respective teaching department during summer or winter break. 邁進地球村系列進修獎 2018-2019GOAL Programme Studentships此項進修獎鼓勵同學參與由書院、大學及具信譽校外團體舉辦的短期非本地的學習計劃及活動。歡迎有興趣同學申請。These studentships allow students to participate in short-term non
14、-local study programmes and activities organized by the College, the University and other reputable outside organizations. Interested students are welcome to apply. 接 受 資 助 承 諾 書Accept the Grant Scheme本人現接受資助款項港幣$ _ 並承諾履行本計劃下列義務：I am now accepting a grant of HK$ _and are committed to fulfilling the
15、following obligations of the Scheme:Requirements 要求(1) 回港兩星期內須向書院輔導處呈上交通及食住費等單據(金額不少於資助額五分之四)、旅程活動報告(約五百中文或英文字)及照片最少兩張，供書院以網頁及在其他書院刊物上刊載或以展板形式等公開展出。You are required to submit within two weeks after your return to Hong Kong, receipts on transport, meals, accommodation and related expenses of your tri
16、p (amount not less than 80% of the grant approved), together with a trip report (about 500 Chinese or English words) and 2 photos at least, for public release in College home page, publications and on display boards, etc.(2) 協助書院推動學生文化交流活動To assist the College in promoting cultural and exchange acti
17、vities.姓名Name：_學號SID：_手提電話Mobile Phone：_銀行名稱Name of Bank：_簽署Signature：_學系/修業年Dept./Year：_香港身份證號碼HKID：_住所電話Home Tel: _銀行戶口號碼Bank Account No.：_日期Date：_ On accepting this offer, please note that you will not be eligible for consideration of other GOAL programmes of the College in this year (between 1 S
18、eptember 2018 and 31 August 2019)聯合書院邁進地球村系列United College Globe-Oriented Active Learning (GOAL) Programme活動報告Report Form中文姓名 Name in Chinese: 英文姓名 Name in English:學號 Student ID： 學系/修業年 Dept./Year：目的地國家 Country: 城巿 City:日期 Date of Trip:活動性質及目的 Activity Nature & Aim:活動報告 Report(五百中文或英文字 Chinese or English 500words)：
