<form method="post" name="APAC_Form_2020_Uniday" action="https://s1133198723.t.eloqua.com/e/f2" id="form4791" class="elq-form" target="_blank"> <input value="APAC_Form_2020_Uniday" type="hidden" name="elqFormName"> <input value="1133198723" type="hidden" name="elqSiteId"> <input name="elqCampaignId" type="hidden"> <div class="layout container-fluid"> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement0" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe66343">Salutation</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select class="elq-item-select" id="fe66343" name="salutation" style="width:100%"> <option value="">Please select...</option> <option value="Miss">Miss</option> <option value="Mr.">Mr.</option> <option value="Mrs.">Mrs.</option> <option value="Ms.">Ms.</option> <option value="Mx.">Mx.</option> <option value="Dr.">Dr.</option> <option value="Prof.">Prof.</option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement1" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65332">First Name</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="firstName" id="fe65332" value="" style="width:100%"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement2" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65333">Last Name</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="lastName" id="fe65333" value="" style="width:100%"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement3" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65331">Email Address<span class="elq-required">*</span></label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="emailAddress" id="fe65331" value="" style="width:100%"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement4" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65334">Mobile Phone</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="mobilePhone" id="fe65334" value="" style="width:100%"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement5" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65356">Business Phone</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="busPhone" id="fe65356" value="" style="width:100%"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement6" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65341">Country</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select class="elq-item-select" id="fe65341" name="country" style="width:100%"> <option value="">Please select...</option> <option value="Afghanistan">Afghanistan</option> <option value="Aland Islands">Aland Islands</option> <option value="Albania">Albania</option> <option value="Algeria">Algeria</option> <option value="American Samoa">American Samoa</option> <option value="Andorra">Andorra</option> <option value="Angola">Angola</option> <option value="Anguilla">Anguilla</option> <option value="Antarctica">Antarctica</option> <option value="Antigua and Barbuda">Antigua and Barbuda</option> <option value="Argentina">Argentina</option> <option value="Armenia">Armenia</option> <option value="Aruba">Aruba</option> <option value="Australia">Australia</option> <option value="Austria">Austria</option> <option value="Azerbaijan">Azerbaijan</option> <option value="Bahamas">Bahamas</option> <option value="Bahrain">Bahrain</option> <option value="Bangladesh">Bangladesh</option> <option value="Barbados">Barbados</option> <option value="Belarus">Belarus</option> <option value="Belgium">Belgium</option> <option value="Belize">Belize</option> <option value="Benin">Benin</option> <option value="Bermuda">Bermuda</option> <option value="Bhutan">Bhutan</option> <option value="Bolivia">Bolivia</option> <option value="Bonaire">Bonaire</option> <option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option> <option value="Botswana">Botswana</option> <option value="Bouvet Island">Bouvet Island</option> <option value="Brazil">Brazil</option> <option value="British Indian Ocean Territory">British Indian Ocean Territory</option> <option value="Brunei Darussalam">Brunei Darussalam</option> <option value="Bulgaria">Bulgaria</option> <option value="Burkina Faso">Burkina Faso</option> <option value="Burundi">Burundi</option> <option value="Cambodia">Cambodia</option> <option value="Cameroon">Cameroon</option> <option value="Canada">Canada</option> <option value="Cape Verde">Cape Verde</option> <option value="Cayman Islands">Cayman Islands</option> <option value="Central African Republic">Central African Republic</option> <option value="Chad">Chad</option> <option value="Chile">Chile</option> <option value="Christmas Island">Christmas Island</option> <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option> <option value="Colombia">Colombia</option> <option value="Comoros">Comoros</option> <option value="Congo">Congo</option> <option value="Cook Islands">Cook Islands</option> <option value="Costa Rica">Costa Rica</option> <option value="Cote d'Ivoire">Cote d'Ivoire</option> <option value="Croatia">Croatia</option> <option value="Cuba">Cuba</option> <option value="Curacao">Curacao</option> <option value="Cyprus">Cyprus</option> <option value="Czech Republic">Czech Republic</option> <option value="Democratic People's Republic of Korea">Democratic People's Republic of Korea</option> <option value="Denmark">Denmark</option> <option value="Djibouti">Djibouti</option> <option value="Dominica">Dominica</option> <option value="Dominican Republic">Dominican Republic</option> <option value="Ecuador">Ecuador</option> <option value="Egypt">Egypt</option> <option value="El Salvador">El Salvador</option> <option value="Equatorial Guinea">Equatorial Guinea</option> <option value="Eritrea">Eritrea</option> <option value="Estonia">Estonia</option> <option value="Ethiopia">Ethiopia</option> <option value="Falkland Islands">Falkland Islands</option> <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option> <option value="Faroe Islands">Faroe Islands</option> <option value="Fiji">Fiji</option> <option value="Finland">Finland</option> <option value="France">France</option> <option value="French Guiana">French Guiana</option> <option value="French Polynesia">French Polynesia</option> <option value="French Southern Territories">French Southern Territories</option> <option value="Gabon">Gabon</option> <option value="Gambia">Gambia</option> <option value="Georgia">Georgia</option> <option value="Germany">Germany</option> <option value="Ghana">Ghana</option> <option value="Gibraltar">Gibraltar</option> <option value="Greece">Greece</option> <option value="Greenland">Greenland</option> <option value="Grenada">Grenada</option> <option value="Guadeloupe">Guadeloupe</option> <option value="Guam">Guam</option> <option value="Guatemala">Guatemala</option> <option value="Guernsey">Guernsey</option> <option value="Guinea">Guinea</option> <option value="Guinea-Bissau">Guinea-Bissau</option> <option value="Guyana">Guyana</option> <option value="Haiti">Haiti</option> <option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option> <option value="Honduras">Honduras</option> <option value="Hong Kong">Hong Kong</option> <option value="Hungary">Hungary</option> <option value="Iceland">Iceland</option> <option value="India">India</option> <option value="Indonesia">Indonesia</option> <option value="Iran">Iran</option> <option value="Iraq">Iraq</option> <option value="Ireland">Ireland</option> <option value="Isle of Man">Isle of Man</option> <option value="Israel">Israel</option> <option value="Italy">Italy</option> <option value="Jamaica">Jamaica</option> <option value="Japan">Japan</option> <option value="Jersey">Jersey</option> <option value="Jordan">Jordan</option> <option value="Kazakhstan">Kazakhstan</option> <option value="Kenya">Kenya</option> <option value="Kiribati">Kiribati</option> <option value="Kosovo">Kosovo</option> <option value="Kuwait">Kuwait</option> <option value="Kyrgyzstan">Kyrgyzstan</option> <option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option> <option value="Latvia">Latvia</option> <option value="Lebanon">Lebanon</option> <option value="Lesotho">Lesotho</option> <option value="Liberia">Liberia</option> <option value="Libya">Libya</option> <option value="Liechtenstein">Liechtenstein</option> <option value="Lithuania">Lithuania</option> <option value="Luxembourg">Luxembourg</option> <option value="Macao">Macao</option> <option value="Macedonia">Macedonia</option> <option value="Madagascar">Madagascar</option> <option value="Malawi">Malawi</option> <option value="Malaysia">Malaysia</option> <option value="Maldives">Maldives</option> <option value="Mali">Mali</option> <option value="Malta">Malta</option> <option value="Marshall Islands">Marshall Islands</option> <option value="Martinique">Martinique</option> <option value="Mauritania">Mauritania</option> <option value="Mauritius">Mauritius</option> <option value="Mayotte">Mayotte</option> <option value="Mexico">Mexico</option> <option value="Micronesia">Micronesia</option> <option value="Moldova">Moldova</option> <option value="Monaco">Monaco</option> <option value="Mongolia">Mongolia</option> <option value="Montenegro">Montenegro</option> <option value="Montserrat">Montserrat</option> <option value="Morocco">Morocco</option> <option value="Mozambique">Mozambique</option> <option value="Myanmar">Myanmar</option> <option value="Namibia">Namibia</option> <option value="Nauru">Nauru</option> <option value="Nepal">Nepal</option> <option value="Netherlands">Netherlands</option> <option value="New Caledonia">New Caledonia</option> <option value="New Zealand">New Zealand</option> <option value="Nicaragua">Nicaragua</option> <option value="Niger">Niger</option> <option value="Nigeria">Nigeria</option> <option value="Niue">Niue</option> <option value="Norfolk Island">Norfolk Island</option> <option value="North Korea">North Korea</option> <option value="Northern Mariana Islands">Northern Mariana Islands</option> <option value="Norway">Norway</option> <option value="Oman">Oman</option> <option value="Pakistan">Pakistan</option> <option value="Palau">Palau</option> <option value="Palestine">Palestine</option> <option value="Panama">Panama</option> <option value="Papua New Guinea">Papua New Guinea</option> <option value="Paraguay">Paraguay</option> <option value="People's Republic of China">People's Republic of China</option> <option value="Peru">Peru</option> <option value="Philippines">Philippines</option> <option value="Pitcairn Group of Islands">Pitcairn Group of Islands</option> <option value="Poland">Poland</option> <option value="Portugal">Portugal</option> <option value="Puerto Rico">Puerto Rico</option> <option value="Qatar">Qatar</option> <option value="Republic of Korea">Republic of Korea</option> <option value="Reunion">Reunion</option> <option value="Romania">Romania</option> <option value="Russian Federation">Russian Federation</option> <option value="Rwanda">Rwanda</option> <option value="Saint Barthelemy">Saint Barthelemy</option> <option value="Saint Helena">Saint Helena</option> <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option> <option value="Saint Lucia">Saint Lucia</option> <option value="Saint Martin">Saint Martin</option> <option value="Saint Martin (French part)">Saint Martin (French part)</option> <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option> <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option> <option value="Samoa">Samoa</option> <option value="San Marino">San Marino</option> <option value="Sao Tome and Principe">Sao Tome and Principe</option> <option value="Saudi Arabia">Saudi Arabia</option> <option value="Senegal">Senegal</option> <option value="Serbia">Serbia</option> <option value="Seychelles">Seychelles</option> <option value="Sierra Leone">Sierra Leone</option> <option value="Singapore">Singapore</option> <option value="Slovakia">Slovakia</option> <option value="Slovenia">Slovenia</option> <option value="Solomon Islands">Solomon Islands</option> <option value="Somalia">Somalia</option> <option value="South Africa">South Africa</option> <option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option> <option value="South Sudan">South Sudan</option> <option value="Spain">Spain</option> <option value="Sri Lanka">Sri Lanka</option> <option value="Sudan">Sudan</option> <option value="Suriname">Suriname</option> <option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option> <option value="Swaziland">Swaziland</option> <option value="Sweden">Sweden</option> <option value="Switzerland">Switzerland</option> <option value="Syrian Arab Republic">Syrian Arab Republic</option> <option value="Taiwan (Republic of China)">Taiwan (Republic of China)</option> <option value="Tajikistan">Tajikistan</option> <option value="Thailand">Thailand</option> <option value="Timor-Leste">Timor-Leste</option> <option value="Togo">Togo</option> <option value="Tokelau">Tokelau</option> <option value="Tonga">Tonga</option> <option value="Trinidad and Tobago">Trinidad and Tobago</option> <option value="Tunisia">Tunisia</option> <option value="Turkey">Turkey</option> <option value="Turkmenistan">Turkmenistan</option> <option value="Turks and Caicos Islands">Turks and Caicos Islands</option> <option value="Tuvalu">Tuvalu</option> <option value="Uganda">Uganda</option> <option value="Ukraine">Ukraine</option> <option value="United Arab Emirates">United Arab Emirates</option> <option value="United Kingdom">United Kingdom</option> <option value="United Republic of Tanzania">United Republic of Tanzania</option> <option value="United States">United States</option> <option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option> <option value="Uruguay">Uruguay</option> <option value="Uzbekistan">Uzbekistan</option> <option value="Vanuatu">Vanuatu</option> <option value="Vatican City State">Vatican City State</option> <option value="Venezuela">Venezuela</option> <option value="Vietnam">Vietnam</option> <option value="Virgin Islands">Virgin Islands</option> <option value="Wallis and Futuna">Wallis and Futuna</option> <option value="Western Sahara">Western Sahara</option> <option value="Yemen">Yemen</option> <option value="Zambia">Zambia</option> <option value="Zimbabwe">Zimbabwe</option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement7" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65335">Institution/Organisation</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="organisation" id="fe65335" value="" style="width:100%"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement8" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65357">Faculty/Department</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="faculty" id="fe65357" value="" style="width:100%"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement9" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65337">Job Title</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="title" id="fe65337" value="" style="width:100%"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement10" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65338">Job Role</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select class="elq-item-select" id="fe65338" name="jobRole1" style="width:100%"> <option value="">Please select…</option> <option value="(DG APAC) Dean/ Department Chair/ Programme Head/ Department Head">Dean/ Programme Head&nbsp;/ Department Head</option> <option value="(DG APAC) Director/Manager">Director/Manager</option> <option value="(DG APAC) Faculty">Faculty</option> <option value="(DG APAC) Head of Research">Head of Research</option> <option value="(DG APAC) Lecturer">Lecturer</option> <option value="(DG APAC) Librarian">Librarian</option> <option value="(DG APAC) Library Director">Library Director</option> <option value="(DG APAC) Postgraduate Student">Postgraduate Student</option> <option value="(DG APAC) President/ Rector/ Chancellor">President/ Rector/ Chancellor</option> <option value="(DG APAC) Professor">Professor</option> <option value="(DG APAC) Provost">Provost</option> <option value="(DG APAC) Researcher">Researcher</option> <option value="(DG APAC) Undergraduate Student">Undergraduate Student</option> <option value="(DG APAC) University Research Administrator">University Research Administrator</option> <option value="(DG APAC) Vice President/ Vice-Rector/ Vice Chancellor">Vice President/ Vice-Rector/ Vice Chancellor</option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement11" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65339">Organisation Type</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select class="elq-item-select" id="fe65339" name="organisationType" style="width:100%"> <option value="Academic ">Academic </option> <option value="Corporate">Corporate</option> <option value="Healthcare">Healthcare</option> <option value="Government">Government</option> <option value="Public Library">Public Library</option> <option value="Other">Other</option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement12" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65340">Subject Area of Interest</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="subjectArea" id="fe65340" value="" style="width:100%"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement13" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65358">Primary area of responsibility</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper" id="fe65358"> <div class="list-order one-column"> <input type="checkbox" id="checkbox-Designing and planning of curriculum_35q4ozsa" value="Designing and planning of curriculum" name="responsibility"> <label class="checkbox-aligned elq-item-label" for="checkbox-Designing and planning of curriculum_35q4ozsa">Designing and planning of curriculum</label> <br> </div> <div class="list-order one-column"> <input type="checkbox" id="checkbox-Teaching_quj6zrsf5" value="Teaching" name="responsibility"> <label class="checkbox-aligned elq-item-label" for="checkbox-Teaching_quj6zrsf5">Teaching</label> <br> </div> <div class="list-order one-column"> <input type="checkbox" id="checkbox-Sourcing and securing of research funding_xjk0n8ajn" value="Sourcing and securing of research funding" name="responsibility"> <label class="checkbox-aligned elq-item-label" for="checkbox-Sourcing and securing of research funding_xjk0n8ajn">Sourcing and securing of research funding</label> <br> </div> <div class="list-order one-column"> <input type="checkbox" id="checkbox-Research_dmqqw3x" value="Research" name="responsibility"> <label class="checkbox-aligned elq-item-label" for="checkbox-Research_dmqqw3x">Research</label> <br> </div> <div class="list-order one-column"> <input type="checkbox" id="checkbox-Others_tv3plyoc" value="Others" name="responsibility"> <label class="checkbox-aligned elq-item-label" for="checkbox-Others_tv3plyoc">Others</label> <br> </div> </div> </div> </div> <div class="form-element-instruction">Please select one</div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement14" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65359">Others, please specify (responsibility)</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input type="text" class="elq-item-input" name="responsibilityOthers" id="fe65359" value="" style="width:100%"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement15" class="elq-field-style form-element-layout row"> <div style="text-align:left" class="col-sm-12 col-xs-12"> <label class="elq-label" for="fe65360">Which stage of the research career are you currently at?</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper" id="fe65360"> <div class="list-order one-column"> <input type="checkbox" id="checkbox-Early-Career_0onkcdfz" value="Early-Career" name="careerStage"> <label class="checkbox-aligned elq-item-label" for="checkbox-Early-Career_0onkcdfz">Early-Career</label> <br> </div> <div class="list-order one-column"> <input type="checkbox" id="checkbox-Mid-Career_88js8zyd" value="Mid-Career" name="careerStage"> <label class="checkbox-aligned elq-item-label" 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