WONG HOCK BOON SOCIETY
Application for Financial Support for
Project/Training/Workshop/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: Geetha Baskaran)
Note
The total amount of financial support for WHB Confirmed Members is up to S$700 per student throughout
the undergraduate years (M1 – M5).
Financial support is subject to the following conditions:

Students must be confirmed (not provisional) members of the Wong Hock Boon Society.

Application will be considered if submitted 2 months before the event.

Financial support is granted primarily to support research projects, training in local /
ASEAN countries.

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.

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 for conference support
Please include supporting documents and indicate N.A (where applicable)
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 ASEAN conferences)
7
Proof of Leave of absence (from Education Section, Dean’s Office)
8
Risk Assessment Form (for ASEAN conferences)
(updated 15 Oct 2012)
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.
Citizenship
Home
____
:
Singaporean
PR of Singapore
Others
5.
Supervisor’s name
:
6.
Department/ Institution
:
7.
Training / Workshop / Conference Details (Please attach brochure / official handout on conference) :
Title
:
Venue
:
Please check
Local
Dates
ASEAN
:
From
Proposed period of leave
8.
Indicate country ______________
to
:
From
to
Nature of Participation (Please attach relevant correspondence eg evidence of paper/poster
acceptance)
Oral Presentation
Poster Presentation
Indicate order of authorship _________________________________________
(a) Title of Paper :
(b) Authors / Co-authors
:
Name
9.
Department
Please state the objectives to be achieved by attendance at this conference :
1 page report to be submitted within 2 weeks after end of conference to Geetha Baskaran
([email protected])
(updated 15 Oct 2012)
2
10. 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
11. Financial assistance received from other sources if expenses at the conference exceed S$700:
(COMPULSORY to complete this section)
No
Yes; details given below and copies of relevant correspondence attached
Source of additional funding:
Amount received from above source
S$
How will the remainder of the cost of the conference will be met?
________________________________________________________________________________________
________________________________________________________________________________________
12.Other financial assistance received from WHB Society previously
Event Title
Venue
From
Amount of Financial
Assistance (S$)
To
13. I declare that the information provided above is correct to the best of my knowledge.
Signature of Applicant:
(updated 15 Oct 2012)
__
3
Date :
PART II - TO BE COMPLETED BY SUPERVISOR(S)
1.
Application for student participation is :
Supported
Comments
Not Supported
:
Please delete where applicable (For ASEAN events)
The student will be travelling alone / accompanied by __________________________ (please specify, if
applicable)
Name of Supervisor(s):
___________________________________
Signature of Supervisor(s):
2.
_____
________
Date:
_______________
To be completed by Head of Department of Supervisor (for NUHS supervisors)
Name of Head of Department: ____________________________
Signature of Head of Department : ___________________
Date: ________________________
PART III - TO BE COMPLETED BY VICE DEAN OF RESEARCH, YONG LOO LIN SCHOOL OF MEDICINE
/ CHAIRPERSON OF CONFERENCE COMMITTEE FOR WONG HOCK BOON SOCIETY
Application is approved:
Yes, for conference leave and financial assistance of S$ ___________________
No
Comments
:
Name of Vice Dean of Research / Chairperson:
_______________________________________________
Signature of Vice Dean of Research / Chairperson:
On behalf of WHB Society Review Committee
(updated 15 Oct 2012)
Date :
4
____