Form

GF001

APPLICATION FORM

PAPER PRESENTATION (ORAL) IPS

APPLICATION REQUIREMENTS/INSTRUCTIONS
1.

Full time active research mode postgraduate student of Universiti Sains Malaysia

2.

All applicants are required to submit their application two months prior the the date
of the conference with the relevant documents :a. Details of conference (e.g. brochures, pamphlet, details of keynote speakers
etc)
b. Offer letter from organiser
c. Quotations of travel expenses
3.

Maximum funding is RM2,000 per student.

4.

Submit complete application form with relevant documents to:

A.

Assistant Registrar
Student Funds & Strategic Networking Unit
Institute of Postgraduate Studies
Universiti Sains Malaysia
11800 Minden, Penang
Malaysia
APPLICANTS PARTICULARS

1.

Name :

2.

I/C / Passport No.:

3. Mailing Address:

4.

E-mail :

5.

Registration Date:

6.

Telephone No. (Handphone) :

School/Centre:

(Lab)

7.

Matric No:

8.

9.

Current Degree:

10. Research Field:

11. Main Supervisor:

12. Co-Supervisor:
( if applicable )

13. Research Title:

IPS Conference Fund Application Form

GF001, Universiti Sains Malaysia

B. CURRENT SCHOLARSHIPS/FINANCIAL ASSISTANCE/RESEARCH UNIVERSITY GRANT

(if any)
1. Sponsor
2. Type

Scholarship / Loan / Scheme / Research University Grant (e.g.

USM-RUPRGS)

3. Monthly
allowance
4. Duration

C.

From:

To:

PUBLICATIONS
( Please provide a copy of the first page of your article in the journal)

1.
2.
3.

D. DECLARATIONS
I hereby certify that all information given in this application is complete and correct to the best
of my knowledge
Name :
Signature :
Date

IPS Conference Fund Application Form

GF001, Universiti Sains Malaysia

E. FOR PAPER PRESENTATION (ORAL) ONLY

1. Name of Conference

2. Organiser

3. Venue of Conference
(City, Country)

4. Date of Conference
5. Deadline for Registration
Fee

6. Title of Paper for Oral Presentation

7. Conference Publication (if known) (Please tick)

Categories

Title / Volume /

a. Peer-Reviewed Journal

b. Proceedings with ISBN

c. Unreviewed Proceeding /
Extended Abstract
(if yes, please proceed to
section 8)
No Information

8. Post Conference Publication

Upon completion of this conference, I plan to
8a. Submit my paper for publication in (state name of journal)
_____________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

9. Budget
(Please indicate estimated budget for paper presentation)

IPS Conference Fund Application Form

GF001, Universiti Sains Malaysia

*
Transportati
on
Cost

Particulars

Type of transportation (Please

circle & state name)

To

Date :

Airline System/
Bus/Train :

Retur
n

Date :

Airline System/
Bus/Train :

Cost (RM)

Total

Registration
Fees
Total
Amount

F. SUPERVISORS REPORT
IPS Conference Fund Application Form
GF001, Universiti Sains Malaysia

1.

(Confidential report to be filled by Main Supervisor)

Name:-

2.

School/Centre:-

3.

Candidates Name:-

4.

Candidates Research Area:-

5. Post-Conference Publication (please circle)

I agree/disagree that this paper can be submitted for publication in a peerreviewed journal after this conference.
6. Please State:a.

Candidates involvement and ability to conduct research:

b. Potentials of the research area:

IPS Conference Fund Application Form

GF001, Universiti Sains Malaysia

c.Supervisors Recommendation:

Signature:

Official Stamp:

Name:
Date:

-------PLEASE LEAVE THIS SECTION BLANK FOR OFFICIAL USAGE------G.SCHOOL DEAN/CENTRE DIRECTORS ENDORSEMENT

Endorsed
Not endorsed
Comment:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Signature :

Official Stamp :

IPS Conference Fund Application Form

GF001, Universiti Sains Malaysia

Name

Date

IPS Conference Fund Application Form

GF001, Universiti Sains Malaysia