APPLICATION FOR CLEARANCE UPON COMPLETION OF STUDIES (For Research Postgraduate Exchange/ Visiting Students Only) 
This form should be submitted to the Graduate School at least seven days before the end of your studies.  Late or incomplete application may result in nullification of the application.

Name: ______________________________________Student No.: _____________________Contact Tel. No. (in HK): ___________________ Contact Email:____________________________

Correspondence Address (after leaving Hong Kong): ________________________________________________________________________________________________________________

My exchange/visiting research study will end on ____________________ and I will leave Hong Kong on ___________________.  I understand the last payment of studentship (if any) will be calculated up to my study end date or last day in Hong Kong (whichever is earlier). I hereby submit my request for clearance.

The University will arrange to issue a letter of certification, the refund of deposit to the student, and the last payment of studentship (if any) after processing this application.
Please indicate the way of collection below:
Funds (the refund of deposit and the last payment of studentship (if any)):
          I will collect the funds by auto transfer. I have updated the 1bank account number and holder’s name at BUniPort before my study period ends. 
          I will collect the funds by personal cheque under my name. Please 2post the cheque to the above correspondence address once ready.
	I will collect the funds by personal cheque under 1a third party’s name. The name is _________________________________. Please contact me when it is ready for pick up.
          I will authorise a person to collect the funds by cash cheque at GS office. I have attached the authorisation form together with this form. Please contact me when it is ready for pick up.
1If the bank account holder is a third party, please ensure the holder’s name is correct. The University bears no responsibility for any possible dispute arisen.
2The University bears no responsibility for any loss or damages of the documents caused by postal delivery.

Letter of certification:
Graduate School will send you the letter of certification upon the completion of clearance procedures via email.

Student’s signature: ___________________________________	Date: ________________________

Please turn over for further information and/or action.

For GS’s Use

	Student Status Record  - CP effective on _____________________	Student Flow Record	CP Letter to student	CP Chop on student file

Deposit to be refunded: 	Yes, HK$____________	N/A 

Clearance done by: __________________Checked by : ______________________ Approved by: _________________________(SAAR)      Date: ___________________________

APPLICATION FOR CLEARANCE STATEMENT
(For Exchange / Visiting Research Students Only)

Name:	__________________________________   Std. No: __________________________________

OFFICE	MATTER FOR CLEARANCE	
COMMENTS & SIGNATURE OF STAFF-IN-CHARGE
	
		Yes/No	Signature	Remarks	
Finance Office (ext 2706)	All Accounts Cleared?				
AML Library	All Books / JULAC Library Card Returned?				
Office of Student Affairs (WLB401) 
(Tel.: 3411 5894 AND 3411-2307)	File cleared?				
	Scholarships & Loans Repaid?				
Dean’s Office	File Cleared? 				
Major Department	File Cleared?				
Principal Supervisor	Endorsed?				
Graduate School (AAB 904)	*Student ID Card Returned?				

* The student must sign the declaration below if the document is lost.

DECLARATION

I, _____________________________________, hereby declare that I have lost my Student ID Card.  I will bear full responsibility for any illegal use of the said document(s).

Signature: ________________________________________	Date: _____________________



Privacy Policy Statement and Personal Information Collection Statement (PPS/PICS)
 
According to the Privacy Policy Statement / Personal Information Collection Statement (PPS/PICS) of the Hong Kong Baptist University (the "University"), personal data of students of the University are collected and retained for a variety of reasons and used for many purposes as such have been set out in the PPS/PICS. Please visit https://www.hkbu.edu.hk/eng/about/privacy.jsp for access to the PPS/PICS.
 
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

SUPERVISOR’S REPORT FORM
(For Principal Supervisor’s Use)

Student’s Name:	__________________________________   Std. No: __________________________________

The student’s performance during the exchange study period is: 

           Excellent	               Good	            Satisfactory	        Unsatisfactory

Other comments: _____________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________

Principal Supervisor’s Name: ____________________________________	Signature: _______________________________________	Date: ________________________