Cyberport University Partnership ProgrammeApplication Form

Notes to Applicant:

Principal Applicant should submit the following documents by email to cityuic@cityu.edu.hk .

1. A completed application form in pdf format2. Copies of CityU student cards of all team members (in one pdf file)3. CVs of all team members (in one pdf file)4. A 2-minute video of your pitching in mp4 format

An email notification will be sent to the Principal Applicant to acknowledge the receipt of the application.

Section A: Principal Applicant Information (who will join the Entrepreneurship Boot Camp overseas)

Name in English (Surname in CAPITAL letters):Click here to enter text.

Name in Chinese:Click here to enter text.

Email: Click here to enter text. Mobile: Click here to enter text.

Student ID: Click here to enter text. (Expected) Graduation Year: Click here to enter text.

Department: Click here to enter text. Academic Qualification (e.g. BBA in Business Analysis):Click here to enter text.

Aged between 18 and 30: ☐Yes ☐No Hong Kong Permanent ID Card Holder :☐Yes ☐No

Relationship with CityU: ☐Current student (undergraduate) ☐Current student (postgraduate) ☐Alumnus (graduated within 3 years)

Section B: Team Member Information

Team Member(s) who will join the Entrepreneurship Boot Camp overseas

Team Member 2 Team Member 3

Name in English (Surname in CAPITAL letters): Click here to enter text. Click here to enter text.

Name in Chinese: Click here to enter text. Click here to enter text.

Email: Click here to enter text. Click here to enter text.

Mobile: Click here to enter text. Click here to enter text.

Student ID: Click here to enter text. Click here to enter text.

(Expected) Graduation Year: Click here to enter text. Click here to enter text.

Department: Click here to enter text. Click here to enter text.

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Academic Qualification (e.g. BBA in Business Analysis):

Click here to enter text. Click here to enter text.

Relationship with CityU:☐Current student (undergraduate) ☐Current student (postgraduate) ☐Alumnus (graduated within 3 years)

☐Current student (undergraduate) ☐Current student (postgraduate) ☐Alumnus (graduated within 3 years)

Team Member(s) who will NOT join the Entrepreneurship Boot Camp overseas

Team Member 4 Team Member 5

Name in English (Surname in CAPITAL letters): Click here to enter text. Click here to enter text.

Name in Chinese: Click here to enter text. Click here to enter text.

Email: Click here to enter text. Click here to enter text.

Mobile: Click here to enter text. Click here to enter text.

Student ID: Click here to enter text. Click here to enter text.

(Expected) Graduation Year: Click here to enter text. Click here to enter text.

Department: Click here to enter text. Click here to enter text.

Academic Qualification (e.g. BBA in Business Analysis):

Click here to enter text. Click here to enter text.

Relationship with CityU:☐Current student (undergraduate) ☐Current student (postgraduate) ☐Alumnus (graduated within 3 years)

☐Current student (undergraduate) ☐Current student (postgraduate) ☐Alumnus (graduated within 3 years)

Section C: Project Details

Project Name in English: Click here to enter text.

Project Name in Chinese: Click here to enter text.

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Project Summary in English (within 300 words):

Click here to enter text.

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Section D: Achievement(s) of Team Members

Academic Achievement:

Click here to enter text.

Award Received:

Click here to enter text.

Entrepreneurship Experience:

Click here to enter text.

Section E: DeclarationI, on my own behalf and on behalf of the Team, hereby declare and acknowledge the below declaration:

The information provided in this application form is true and accurate up to the day of submitting this application form and to the best of my/our knowledge.

The projects ideas proposed in this application are original and without infringement of intellectual property rights of any others.

I agree and understand that the information provided in this application form will be vetted by KTO staff and/or external advisors for assessment and record purpose.

I give my/our consent to KTO staff to carry out necessary due diligence/reference check for the purpose of assessing this application.

I have obligations to update the information submitted in this form and inform KTO staff immediately if there are any changes to the information I have provided to KTO.

I hereby acknowledge that CityU can make use of my/our case for promotional purposes if my/our application is approved.

Click here to enter a date.

Signature by Principal Applicant(for and on behalf of the Team)

Date

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