Student Application Form (Fall 2012) - UROP

UROP Student Application Form (Fall 2012) Page 1 of 2Undergraduate Research Opportunities Program (UROP)Student Application Form (Fall 2012)APPLICATION DEADLINES: Online – 12 SEPT; Documents – 14 SEPTDocuments MUST be submitted either in person to Room 4592, Lift 29-30 OR by email to urop@ust.hk.(Please refer to http://urop.ust.hk/how_to_apply.html for a list of required documents.)(Part I – III should be completed by the Applicant. Part IV should be completed by the Supervising Faculty)Part I – Student InformationName of Student:Student ID:*HKID Card No.:*For non-local students onlyPart II –Project DetailsMajor/Year:Email:Mobile No.:A. Project Title: ___________________________________________________________________(MUST be the same as the online application submitted.)B. Name(s) of Supervisor & Co-Supervisor (if any):_________________________________________C. Course Type (please tick one of the boxes as appropriate):UROP1000* UROP 1100*Only in SUMMER, for stipend& CANNOT be repeated.UROP1200^UROP1300^^PRE-REQUISITE required; please refer tohttp://urop.ust.hk/program.html for details.D. Project Description, Applicant’s Role(s), Applicant’s Learning Objectives & Personal Statement(Note: Personal Statement compulsory for UROP1000/1100 and optional for UROP1200/1300). Attach a copy of the online application acknowledgement email, with project description,applicant’s role(s), applicant’s learning objectives and personal statement listed in detail.Part III – Declaration by the Applicant (Please tick the boxes below): I declare the information provided in my UROP application is accurate and complete. I understandthat any false, incomplete or misrepresented data may result in disqualification of my application. I understand UROP is an opportunity for me to gain experience in research, and it does notconstitute an employer-employee relationship between my supervisor(s) and myself. If my application is successful, I undertake to complete the project to the satisfaction of my projectsupervisor(s), and submit report according to the length and format required by the UROP Office. I understand that the stipend (for UROP1000 only) or course grade (for UROP1100/1200/1300)will be released upon completion of the project and evaluation of the final report by mysupervisor(s). I understand that if I am under the supervision in my UROP Project and Final Year Project by thesame faculty member(s), my contributions in UROP (inclusive of all courses in the series, i.e.UROP1100/1200/1300) shall NOT constitute more than 50% of my Final Year Project.Signature of the Applicant:Full Name (IN BLOCK LETTERS):_____________________________Date:_____________________________________________________

UROP Student Application Form (Fall 2012) Page 2 of 2Part IV – Consent and Undertaking by the Supervisor(s) (Please tick the boxes below):Note to Supervisor(s):1. Please only give your consent if you are committed to be the Applicant’s supervisor, and if the Applicanthas completed Part I – III of the Application Form in full;2. If you cannot sign the form in person, please email the applicant to give your consent & c.c.urop@ust.hk. I have reviewed the Applicant’s details and his/her personal statement, and I agree to be his/hersupervisor, if the application is successful. I agree to follow the grade reporting procedure and schedule as specified by the UROP Office, forthe release of final grade or stipend (for UROP1000 only) to the Applicant upon projectcompletion. (Check only if the project involves animal or human participants and relevant safety procedures)I confirm that the project will involve animal or human participants, and it will be conducted underthe basic principles of the University’s Procedures for Research Practice. Appropriate approvalhas been / will be (delete as appropriate) sought, and the Applicant will be given safety training forlaboratory usage prior to the start of the project. I confirm that my laboratory has enough resources to support the project, and no additionalresources and/or funding are required. The Applicant will be given safety training for laboratoryusage prior to the start of the project. I understand that if I am supervising the same Applicant in his/her UROP Project and Final YearProject, his/her contribution in UROP (inclusive of all courses in the series, i.e.UROP1100/1200/1300) shall NOT constitute more than 50% of his/her Final Year Project.Signature of the Supervisor:Signature of the Co-supervisor:_____________________________Full Name (IN BLOCK LETTERS):_____________________________Date:______________________________________________________Full Name (IN BLOCK LETTERS):_____________________________Date:_________________________For UROP Office Use OnlyDate of ReceiptSupporting Documents Attached: (Y/N) Documents Checked On: ____________Application Result:(Firm Offer / Conditional Offer / Not Approved – reason ____________________ )Notification Sent On:Course Enrollment Completed On: _____________ Course Code: ____________