STEM Internship Scheme 2020/2021
Careers and Placement Section, Student Affairs Office
The Hong Kong Polytechnic University
Student Online Application Form

Statement of Declaration

This Form aims at collecting applicants’ data and declaration for the STEM Internship Scheme 2020/2021 administrated by the Careers and Placement Section (CPS), Student Affairs Office. The data provided by you will be handled in compliance with PolyU’s Privacy Policy.


Please submit this application form AFTER confirming the STEM internship offer.

Personal Information

Student Name (as on HKID)

Student ID Number

Email Address

Contact Number (in Hong Kong)

Contact Number (in homeland outside Hong Kong, if any)

Date of Birth

Format: mm-dd-yyyy

Department/Major of Studies

 Major of studies NOT on the list are NOT eligible for the Scheme

Year of Study


Expiry of Student Status (as shown on your Student ID card)

Note of Eligibility

As required by the Innovation and Technology Commission (ITC), HKSAR Government, the Scheme is open to local students (the definition of which is in accordance with the classification by the Education Bureau, HKSAR Government for the purpose of admission to post-secondary programmes^).

I confirm that I am eligible for the Scheme.


^According to the Education Bureau, holders of the following documents are classified as local students –

  • Hong Kong Permanent Identity Card;
  • Documents issued by the Hong Kong Immigration Department certifying the right of abode / right to land in Hong Kong;
  • Document of Identity / One-way permit for entry to Hong Kong;
  • Dependant visa / entry permit (for students who were below 18 years old when they were issued with such visa / entry permit by the Director of Immigration);
  • Full-time employment visa / work permit (for part-time study);
  • Visa / entry permit for Quality Migrant Admission Scheme;
  • Visa / entry permit for Capital Investment Entrant Scheme;
  • Visa / Entry permit for Admission Scheme for the Second Generation of Chinese Hong Kong Permanent Residents; or
  • Visa label for unconditional stay.

Internship Information

Name of Organisation

Internship Title

Internship Period (from)

Format: mm-dd-yyyy

Internship Period (to)

Format: mm-dd-yyyy

Internship Location

Hong Kong
Chinese mainland

Job Description (as advertised)

Honorarium per month (HKD)

 (fill in “0” if not applicable)

Total Honorarium (HKD)

 (fill in “0” if not applicable)

Name of Contact Person

 (Contact person can be HR personnel or work supervisor)

Email of Contact Person

Contact Number of Contact Person

Source of Internship

CPS (STEM-internship on PolyU Job Board)

Upload Documents

Employment Contract


Rename as Student ID_Name_EmploymentContract.pdf


Students who cannot provide the employment contract by the Scheme application deadline please upload a copy of the email confirmation issued by employers as evidence. Students must submit the employment contract to CPS ( at least two days before the commencement of internship.

Student Charter (Click HERE to download)


Please download the document to fill in the information.

Rename as Student ID_Name_S1_StudentCharter.pdf 

Copy of Student ID Card


Rename as Student ID_Name_StudentCard.pdf



Personal Data

The personal data provided by you to CPS will be collected, retained, processed, used and transferred (within or outside of Hong Kong) for the following purposes:

  • Processing your inquiries, application, registration or request for services, activities and facilities;

  • Facilitating communications with you;

  • Facilitating implementation of PolyU’s policies and procedures, and monitoring compliance with the same;

  • Enabling PolyU to comply with any applicable procedures, laws, regulations or court orders (in each case whether in Hong Kong or overseas), any requests by government, statutory, regulatory or law enforcement authority, and valid legal processes, ordinances obligations;

  • Conducting quality assurance, surveys and review, statistical analysis, and research; and

  • Other purposes directly relating to any of the above.

You are required to provide your personal data, other than those items indicated as optional. Failure to provide such data may lead to inability to process your application, registration or request for services, activities and facilities, or maintain contact with you.

Please read the Personal Information Collection Statement of CPS carefully:


Learning Journal and Photos

The Learning Journal and photos submitted by you to CPS as post-internship documents for the Scheme may be used for marketing purposes. Please note PolyU or CPS websites and social media can be accessed anywhere with Internet coverage. Your personal data will NOT be included in our marketing materials.

a. I have read and agree to the Personal Information Collection Statement of CPS.

b. I understand and agree that my Learning Journal and/or photos submitted for the Scheme may be used for marketing purposes.


  1. I understand that PolyU has the rights to verify my personal data provided in this Form and I authorise CPS to cross check all of the above data provided by me with relevant parties.


  1. I declare that the internship which is used to apply for the Scheme is NOT able to serve as fulfilment of WIE requirements.


  1. I understand that if I give any incorrect data or withhold any relevant data, I shall render myself liable to the revocation of my enrolment on the Scheme.


  (Student Name), declare that the data submitted is true and complete to the best of my knowledge and belief.