NLSE Form A

THE HONG KONG UNIVERSITY OF SCIENCE & TECHNOLOGY

Endorsement of Study/Curriculum-Related Internship for Non-Local Students
Ref No :

Remarks:
(1) Full-time non-local students should complete this form to seek endorsement of an internship as study/curriculum-related from the School
Designated Officer, before they start the internship.
(2) Please read and follow the rules and procedures for study/curriculum-related internships to be taken up by non-local students. In case of
doubt, please consult the Career Center of the Student Affairs Office.

Section A (To be completed by the non-local student)

A1: Student's Personal Particulars
Surname: Given Names (in Full): Name in Chinese (if applicable) :

Title: HKUST Student No: HKUST Email Address: Mobile Phone:

Mr / Miss / Others ( )
Correspondence Address:

Enrollment and Program Details:

Undergraduate School: Program: Year of Study:
Current CGA: Current SGA: Academic probation: □ No
□ Yes

Taught Postgraduate School: Program: Year of Study:

In possession of the No-Objection-Letter (NOL) for undertaking internship? □ No □ Yes

Note : Non-local students must hold a valid NOL before taking up an internship. Those without should apply to the HK Immigration Department for
the NOL after the internship has been endorsed.

A2: Internship Information (Attach a copy of the internship offer letter, if available)
Name of Company: Officer-in-Charge / Supervisor
Name:

Company Address: Title:

Telephone No:

Email Address:

Position Title: Working Hours:

Job Duties: Learning Objectives and Intended Outcomes:

Period: From □□ / □□ / □□ To □□ / □□ / □□ □ Fall □ Winter □ Spring □ Summer

( DD / MM / YY ) ( DD / MM / YY ) (May check more than one box)

Duration of internships completed before (if any) : □□ months (From □□ / □□ / □□ To □□ / □□ / □□)

( DD / MM / YY ) ( DD / MM / YY )

Total duration of all internships taken up by the student (including internship(s) completed before and the one being applied for):
□□ months
(Note: Total duration must not exceed one year, or one-third of the normal duration of the student's program, whichever is the shorter)
A3: Declaration by the Student
(1) I certify that all information contained in this application is true and complete to the best of my knowledge.
(2) I agree to abide by the rules and regulations as promulgated by HKUST or the Immigration Department of the HKSAR
Government in regard to study/curriculum-related internships undertaken by non-local students.
(3) I understand and accept that:
(a) I shall report any changes in the terms and conditions of my internship and seek further approval for such changes;
(b) I shall submit a copy of the employer's reference stating my internship period as soon as it is made available to me;
(c) I will submit a copy of the employer's evaluation report on my performance in the internship if it is available.

Student's Signature Date

Section B (To be completed by the Student's major department, if applicable)

Endorsement by Department (Please refer to the endorsement guidelines)
Details about how student learning in this internship are to be assessed:
Decision:

□ Application is supported

□ Application is not supported

Other remarks: (e.g. impact on study load or time of program completion)

Department Name of Endorsing Officer: Signature: Date:

Section C (To be completed by the Student's School)

Endorsement by the School Designated Officer (Please refer to relevant rules and endorsement guidelines)
Details about how student learning in this internship are to be assessed:
Decision:

□ Application is endorsed

□ Application is not endorsed

Other remarks: (e.g. impact on study load or time of program completion)

School Name of Designated Officer: Signature: Date:

For School Office Use

Student is notified on:

Student submits employer's reference letter on:
This form can be removed from the School record after 5 years on: □□ / □□ / □□ (DD/MM/YY)