Inbound Research Mobility Scheme 2017-18

Application Form for Visiting Faculty Members

If you encounter any problems when filling in this form, please contact mobilityscheme@cuhk.edu.hk.

Section 1. Personal Particulars
Title (Dr./Miss/Mr./Ms./Prof.) *
Name Name * First Last
Name of Home Institution *
Country of Home Institution *
Country of Home Institution: If others, please specify. *
Department/Unit/Faculty *
Position *
Email *
Contact Phone No *
Work Address *
Employment at Home Institution *

Employment at Home Institution Full-time Part-time
Are you tenured?
Note: In the event that there is less than a year of employment in your current contract after the proposed visit, your application should be supported by the Department/Unit Head (or an appropriate higher authority) with specification of intention of contract renewal. Please complete section 2 in the Endorsement Form. *

Are you tenured?
Note: In the event that there is less than a year of employment in your current contract after the proposed visit, your application should be supported by the Department/Unit Head (or an appropriate higher authority) with specification of intention of contract renewal. Please complete section 2 in the Endorsement Form. Yes No
Please indicate the end date of the current contract. Please indicate the end date of the current contract. * / MM / DD YYYY
Will you retire from your current employment within a year after the proposed visit? *

Will you retire from your current employment within a year after the proposed visit? Yes No
Please indicate your retirement date. Please indicate your retirement date. * / MM / DD YYYY
Have you been accepted as a visiting scholar with remuneration at CUHK during the proposed visit? *

Have you been accepted as a visiting scholar with remuneration at CUHK during the proposed visit? Yes No
Please provide details including the visit period (DD/MM/YY). *
Please indicate if you have received an award from any of the following CUHK schemes in the past and give details in the below.

Please indicate if you have received an award from any of the following CUHK schemes in the past and give details in the below. Inbound Research Mobility Scheme Bilateral Teaching Exchange Programme Short-term Faculty Exchange Programme CUHK-University of Manchester Research Fund
Inbound Research Mobility Scheme
Award Year *
Bilateral Teaching Exchange Programme
Award Year *
Short-term Faculty Exchange Programme
Award Year *
CUHK-University of Manchester Research Fund
Award Year *
Section 2. Visit Details at CUHK
CUHK Host Department *
CUHK Host Collaborator Title (Dr./Miss/Mr./Ms./Prof.) *
CUHK Host Collaborator Name CUHK Host Collaborator Name * First Last
CUHK Host Collaborator Position *
Proposed Visit Start Date
(The proposed visit could last for up to 7 nights.) Proposed Visit Start Date
(The proposed visit could last for up to 7 nights.) * / MM / DD YYYY
Proposed Visit End Date Proposed Visit End Date * / MM / DD YYYY
Proposed Visit: No. of Nights *
Have you been/will you be supported by any funding sources for the proposed visit? *

Have you been/will you be supported by any funding sources for the proposed visit? Yes (Please attach supporting document, if any.) No
Source of funding support *
Amount of funding support
(e.g. HKD 3,000) *
Have you been/will you be supported by any CUHK/local/international research funds for the proposed research collaboration? *

Have you been/will you be supported by any CUHK/local/international research funds for the proposed research collaboration? Yes (Please attach support document, if any.) No
Source of research fund *
Amount of research fund
(e.g. HKD 3,000) *
Section 3. Collaboration Ties and Research Background
This application is in support of *

This application is in support of Existing collaboration/ties New collaboration/ties
Please give details on all previous and current collaboration/ties with the CUHK host department/collaborator, including joint research, exchange activities, joint seminars/conferences, publications, etc.

Please provide justifications for a repeated visit if you have received support from a CUHK scheme listed in Section 1 to visit CUHK before. *
Maximum of 300 words allowed. Currently Entered: 0 words.
Please state your research area(s) that is relevant to your proposed visit to CUHK. *
Maximum of 20 words allowed. Currently Entered: 0 words.
Please describe the research activities you conducted at your institution in the past year that is relevant to your proposed visit to CUHK in layman’s terms. *
Maximum of 200 words allowed. Currently Entered: 0 words.
Section 4. Proposed Visit
Please describe your visit’s purposes in layman’s terms. *
Maximum of 100 words allowed. Currently Entered: 0 words.
Please describe the detailed plan of the visit with activities to be undertaken and people to be met at CUHK in layman’s terms. *
Maximum of 200 words allowed. Currently Entered: 0 words.
Please highlight possible areas of collaboration and possible impact on research collaboration between your institution and CUHK in layman’s terms. *
Maximum of 200 words allowed. Currently Entered: 0 words.
Declaration by Applicant
*

I declare that the statements made and information given in this application are, to the best of my knowledge, true, complete, and correct. I have read and fully understand the “Guidelines for Applicants”. I understand that the personal data provided in this form will be used by the relevant committees and authorised personnel responsible for handling applications for the award.
Section 5. Supporting Documents
(A) Letter of invitation from the CUHK host department
(in DOC/DOCX/JPG/PDF format) *

Attach Files
(B) Applicant’s Curriculum Vitae with publication records
(in DOC/DOCX/JPG/PDF format) *

Attach Files
(C) Copy of notification of financial support for the proposed visit/research collaboration with CUHK, if any
(in DOC/DOCX/JPG/PDF format)

Attach Files
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Disclaimer The personal data collected will be used by Office of Academic Links (OAL) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.

Inbound Research Mobility Scheme 2017-18

Section 1. Personal Particulars

Section 2. Visit Details at CUHK

Section 3. Collaboration Ties and Research Background

Section 4. Proposed Visit

Declaration by Applicant

Section 5. Supporting Documents