WONG HOCK BOON SOCIETY
Application for Financial Assistance for Conferences
The application should be submitted through the student’s supervisor to:
NUHS Research Division
Dean’s Office
Yong Loo Lin School of Medicine
Level 11, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228
(Attention: Wong Hock Boon Society Secretariat)
Guidelines
The total amount of financial assistance for conferences will be supported up to S$700 per student throughout
the undergraduate years (M1 – M5).
Students are strongly encouraged to apply for financial assistance for local/regional conferences. As
funds are limited, any top-up of funding for the conference should be pre-arranged with the supervisor.
Financial assistance, if granted, is subject to the following conditions:

Students must be confirmed (not provisional) members of the Wong Hock Boon Society.

Financial assistance is provided on a reimbursement basis.

Financial assistance will cover expenses for the most economical airfare by the most direct
route (quotation from NUS-appointed travel agent), hotel accommodation and student
registration fees. Total amount supported will not exceed S$700.

Conference funding review meeting will be held every 2 months by the Committee

This funding is a privilege and not a right.
Checklist of documents for submission (Kindly include/note) :
Applicant must either be presenting an oral or poster presentation (must be first author) for
consideration for funding
1
Abstract of conference paper (including order of authorship)
2
Invitation email from organizer for presentation
3
Quotation for airfare – economy class (from Price Breaker, pls see guidelines and details in the
application form )
4
Registration Fee
5
Hotel accommodation (if applicable)
6
Indemnity Form (for overseas conferences only)
7
Proof of Leave of absence
(updated 3 Nov 2011)
1
PART I - TO BE COMPLETED BY APPLICANT
1.
Name (Mr/Miss)
:
Student Matriculation. No. :
2.
Year of Study
:
M1 / M2 / M3 / M4 / M5
3.
Contact Numbers
:
HP
4.
Supervisor(s)
:
5.
Department(s)
:
6.
Citizenship
8.
____
:
Singaporean
7.
Home
PR of Singapore
Others
Conference Details (Please attach brochure / official handout on conference) :
Title
:
Venue
:
Dates
:
From
Nature of Attendance
to
:
Open to all
By Invitation
By Nomination; specify nominating body _____________________________________________
9.
Nature of Participation (Please attach relevant correspondence eg evidence of paper/poster acceptance)
Oral Presentation of a Paper
10.
Poster Presentation
Details of Paper / Address to be presented at Conference :
(a) Title of Paper / Address :
(b) Authors / Co-authors
:
Name
Department
(c) Paper accepted for presentation at conference:
Yes
No
(d) Paper has been presented previously / substantially presented previously :
Yes; details given below
(updated 3 Nov 2011)
No
2
Name of Conference and Previous Presentation
Dates of Conference
11. Please state the objectives to be achieved by attendance at this conference :
12. Details of previous conference/s attended as YLL SOM undergraduate student :
Conference Title
13. Proposed period of leave :
Venue
From
To
From
Amount of
Financial
Assistance (S$)
Source of
Financial
Assistance
to
14. Financial assistance requested, details given below :
No.
Description
Cost (S$)
a.
Airfare* (Please attach quotation from authorized travel agent)
b.
Hotel Accommodation (Cap based on NUS guidelines)
c.
Student Registration Fee
Funding
Requested (S$)
TOTAL
*The NUS appointed travel agent is Pacific Arena Private Limited. Pacific Arena also operates under the brand name of PriceBreaker.
Students are not required to make their bookings with Pacific Arena if they can purchase cheaper tickets from other agents. Please note that
these tickets are usually highly restrictive Please compare the full service airline’s fare with a quote from Pacific Arena for instant purchase
fare, on the same airline and route before buying the airticket. The fare comparison must be submitted to support the claim for airfare
reimbursement. Pacific Arena has a dedicated team servicing NUS. Please call or email Pacific Arena’s travel consultants for quotations and
bookings. Email: [email protected]. Tel: 6317 2110
15. Financial assistance received from other sources if expenses at the conference exceed S$700:
(COMPULSORY to complete this section)
No
Yes; details given below and copies of relevant correspondence attached
Source :
Amount of top-up available
:
S$
How will the remainder of the cost of the conference will be met?
________________________________________________________________________________________
________________________________________________________________________________________
(updated 3 Nov 2011)
3
16. I declare that the information provided above is correct to the best of my knowledge.
Signature of Applicant:
__
Date :
PART II - TO BE COMPLETED BY SUPERVISOR(S)
1.
Application is supported :
Yes
Comments
2.
No
:
I declare that the above student has not yet received financial support of S$700/- from the Wong Hock
Boon Society while under my supervision.
Name of Supervisor(s):
___________________________________
Signature of Supervisor(s):
3.
_____
________
Date:
_______________
To be completed by Head of Department of Supervisor (for NUHS supervisors)
Name of Head of Department: ____________________________
Signature of Head of Department : ___________________
Date: ________________________
PART III - TO BE COMPLETED BY VICE DEAN OF RESEARCH, YONG LOO LIN SCHOOL OF MEDICINE
/ CHAIRPERSON OF CONFERENCE COMMITTEE FOR WONG HOCK BOON SOCIETY
Application is approved:
Yes, for conference leave and financial assistance of S$ ___________________
No
Comments
:
Name of Vice Dean of Research / Chairperson:
_______________________________________________
Signature of Vice Dean of Research / Chairperson:
(updated 3 Nov 2011)
Date :
4
____