JIRS CLEAR/10/1
HONG KONG BAPTIST UNIVERSITY
GRADUATE SCHOOL

APPLICATION FOR CLEARANCE ON LAST VISIT TO HKBU
(For JIRS Visiting Students Only)

This form should be submitted to the Graduate School at the end of your visit.  Late or incomplete application may result in nullification of the application.

Name: ________________________________________	Student No.: _______________	Department: ___________________	Contact Tel. No. (in Hong Kong): ________________
Correspondence Address	
(after leaving Hong Kong): __________________________________________________________________________________________________________________________________

My last visit to HKBU will end on ____________________ and I will leave Hong Kong on ___________________.  A copy of my jetfoil/bus ticket for departure is enclosed, and I hereby submit my request for clearance.

Please note that the last payment of your stipend/allowance will be calculated up to your visit end date or your last day in Hong Kong (whichever the earlier). 

Student’s signature: ___________________________________	Date: ________________________������

HKBU Principal/Co-supervisor’s Name: ____________________________________	Signature: _______________________________________	Date: ________________________
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��For Office’s Use Only	

Form Received by:  ________________________________ on ________________________________

	Clearance done by: ________________________________	

	Approved by: ______________________________________	Date: __________________________________
Executive Associate Dean of Graduate School

OFFICE	MATTER FOR CLEARANCE	
COMMENTS & SIGNATURE OF STAFF-IN-CHARGE
	
		Yes/No	Signature	Remarks	
Finance Office (RRS 802 – ext 5112 / 2574)
Counter hours - Mon~Fri : 9:00am ~ 1:00pm
                                           2:00pm ~ 5:40pm	All Accounts Cleared?				
AML Library	All Books / JULAC Library Card Returned?				
Dean’s Office	Endorsed? 				
Major Department	Endorsed?				

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Personal Information Collection Statement

Persons who supply personal data in their applications to the Graduate School for various purposes are requested to note the following:
1.	Personal data provided in the applications are to facilitate the process of their applications and will not be used for other purposes.
2.	Personal data provided will only be used by University staff.
3.	After the applications have been processed, relevant data will be transferred to the student record system of the University.

Under the provision of the Personal Data (Privacy) Ordinance, request for personal data access or correction may be made and addressed to:
 	Graduate School
	AAB 904, Level 9, Academic and Administration Building
	Baptist University Road Campus
	Hong Kong Baptist University
	Kowloon Tong
	Kowloon, Hong Kong