(2021/2022 1st Term) , The Chinese University of Application form for Student Activity Subsidy Scheme (For Registered Chung Chi College Student Society Only)

(1) Guidance Notes: 1. Please ensure that all parts in the form are completed and the information is true and accurate. If there are any differences between the final claimed and originally approved subsidy amount and no reasonable explanation is provided, the Dean of Students’ Office reserve the final decision on all approval and subsidy arrangements. 2. Activities that do not request for subsidy should also listed together for Office reference. 3. Application deadline: September 27, 2021 (Monday) 4. Result letter of Student Activity Subsidy Scheme will be sent to each student society’s post box on October 11, 2021 (Monday). (Besides the Office of Chung Chi College Student Union, 4/F, Pommerenke Student Centre) 5. For enquiries, please contact Ms. Jessica Chan at 3943 6993 or Ms. Catherine Chung at 3943 8009.

(2) Name of Society:【Should consistent with the name of student society’s stamp.】

______

(3) Financial Budget: The following information is the financial budget of this student society from June 1, 2021 to December 31, 2021.

Activity Other income or subsidy For Office use only Date of No. of Proposed amount for Name and 【Please specify the sources Activity Participants subsidy application Purpose of subsidy and amount】 Approved amount

Name: Source： 1. Purpose: Amount：

Name: Source： 2. Purpose: Amount：

Name: Source： 3. Purpose: Amount：

Name: Source： 4. Purpose: Amount：

Name: Source： 5. Purpose: Amount：

Total： $ $ 【Please make photocopies if more forms are required.】 1

File:/DS/117/4/申請表格(Eng)_20210910 (2021/2022 1st Term) (4) Income of Student Society:

Total number of existing members：

Distribution of Members in the Colleges: (Chung Chi College: ______, : ______, Shaw College: ______, United College: ______, Morningside College: ______, SHHO College: ______, : ______, C.W. Chu College: ______, : ______)

Membership fee per person: $ (Pay _____time(s) a year)

Membership fee reserve：$ 【Please refer to the Financial report of the First Half of 2021.】

Other income or subsidy： ______【e.g. The Office of Student Affairs of CUHK, other Colleges, Funding from HSBC, The Federation of Alumni Associations of the CUHK, other organizations etc.】

(5) Society Website/Factbook/Instagram page (If any):

(6) Information of Applicant:

Name: College／Major／Year:

Position: Contact no :

Email address: @link.cuhk.edu.hk／

(7) Declaration:

I______(Name of Applicant), representing ______(Name of student society) hereby declare that all parts in the form are completed and the information is true and correct.

Applicant Signature： Date：

Society Stamp:

2

File:/DS/117/4/申請表格(Eng)_20210910