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7. Expression of Interest: The University Innovation Fellows at Stanford University’s Hasso Plattner Institute of Design

Expression of Interest: The University Innovation Fellows at Stanford University’s Hasso Plattner Institute of Design

Please complete all fields on the form and click the Submit button.

Required fields are marked with an asterisk (*)

Student Details

Student Name *

Student ID Number *

Contact Number *

Email * (student email only)

Gender

Academic Information

When do you intend to graduate? * (Semester / Year - E.g. 2/2018)

Current year of study *

-- Please Select --Year 1Year 2Year 3Year 4

Current UC Degree *

Grade Point Average (GPA) *

Supporting Documents

Current Transcript/ Statement of Grades * (PDF or Word format)

Statement of Purpose * (Word or PDF format)

CV * (PDF or Word format, no more than 8 pages)

Student Participation Agreement & Certification

I agree to observe the conditions of my program as follows:

• I agree to check my student email account for correspondence from UC.
• I understand I will be required to pay for the appropriate corresponding UC unit(s). I also understand that I may be required to pay the additional program fees associated with the program.
• I accept the sole responsibility for payment of all other expenses and debts incurred by me while participating in the Program.
• I understand that awarding of academic credit for study completed is at the discretion of my UC course/unit convenor.
• I agree to attend classes and extra-curricular activities as outlined in my program . I also agree to complete the program requirements as requested.
• I will conduct myself in strict accordance with UC’s Student Code of Conduct and also in compliance with the policies, rules, and regulations prescribed by UC the host organisation or company etc.
• My placement may be terminated early if I fail to follow the specified instructions, and necessities requested of me for the program. I am responsible for any financial obligations related to the withdrawal from the Program.
• I will inform the University of Canberra immediately if I am unable to participate in the Program after having signed this agreement
• I will declare any pre-existing conditions that I have that may affect my ability to participate fully in the program.
• I understand that the program itinerary is subject to change and organisers reserve the right to adjust and modify plans if and when necessity arises.
• I understand that UC has the authority to terminate, at any time, my program participation if I fail to adhere to the regulations of the program and/or behave in a manner in any way that the organiser deems to:
  • Significantly lower the quality of the field school experience for others
  • Endanger oneself or anyone else
  • Damage relations between the group, the local people or the host institution
  • Be culturally insensitive
  • Damage the reputation of UC

I agree to all of the above statements *

• YES

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Certification

Full Name *

Date *

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