<p> City University of Hong Kong Student Development Services Student Life and Resources Section STUDENT ACTIVITIES FUND (for local activities)</p><p>Reference No. (For office use only) Application Form (Please type or write clearly in black)</p><p>Notes to applicants :</p><p>1. Please read the guidelines of Student Activities Fund (for local activities) before completing the application form. 2. Personal data provided in this form will be used only for processing the application and related administrative matters. 3. The completed form with relevant documents should be submitted to Student Development Services (6/F, Amenities Building). 4. Applicants must specify the amount of funding obtained from external and/or other departments. 5. Any misrepresentation of facts will lead to disqualification of the subsidy and render applicant liable to disciplinary action by the University. And the University reserves the right to demand the subsidy recipients for refunding, partially or in full, if they fail to fulfill the obligation(s) as required.</p><p>Name of Applicant (Leader of the Activity): (Mr. / Miss) ______</p><p>Name of Society (if applicable): ______</p><p>Post (if applicable): ______Student ID No.:______</p><p>Program / Year: ______E-mail address: ______</p><p>Contact Tel No.: ______Mailbox / locker No.: ______</p><p>1. Name of Activity: </p><p>2. Proposed Date(s) / Period: </p><p>3. Objective(s) of the Activity:</p><p>4. Programme Content: (Please specify date, time, programme rundown and venue. Attach the details if available.)</p><p>5. How do the programme objectives and content relate to the following directions? 1 (Please refer to the attached guidelines for details.)</p><p>C  Community Outreach</p><p>I  Internationalization</p><p>A  Academic Integration</p><p>6. Target Participants:</p><p>No. of persons involved in organizing the activity: (Please attach organization structure, name-list & student I.D. if available)</p><p>City University students others (please specify)</p><p>No. of persons expected to participate in the programme: (Please attach name-list & student I.D. if available)</p><p>City University students others (please specify)</p><p>7. Advisor(s), if any: (Please attach recommendation letter(s) if available.)</p><p>8. Work Schedule: (Please specify dates and tasks / actions)</p><p>9. Follow-up plan / activities:</p><p>2 10. Measurement of programme outcomes:</p><p>11. Budget for the Activity: (Please list out the detailed breakdown of the income and expenditure items):</p><p>For Office Use Expenditure HK$</p><p>Total:</p><p>Income Programme / enrolment fee from participants:</p><p>Budget from society / club:</p><p>Funding from University / College / School / Dept.:</p><p>3 External sponsorship:</p><p>Total:</p><p>Subsidy Requested from SDS:</p><p>Total:</p><p>Remarks: Please attach all relevant supporting documents and recommendations if available.</p><p>I have read and will follow the guidelines for application of Student Activities Fund.</p><p>Signature of Applicant Stamp of Student Society Date (if applicable)</p><p>Students’ Union Endorsement (Applications submitted by SU student societies should be endorsed by the SU President / Council.)</p><p>Endorsed by: Date: SU President / Council</p><p>For Office Use Only</p><p>Comments:</p><p>______</p><p>______</p><p>______</p><p>______</p><p>Responsible Staff Date</p><p> Application received ______ Interview (if any) ______ Amount recommended: HK$ Source of fund:  SA Fund</p><p>4  Other source (please specify): ______ Amount approved: HK$ from the recommended source of fund ______ Recorded ______ Reply letter (c.c. SU President & Council / Dept / Div) ______ Report, audited financial statement & receipts (Deadline: ) ______ Reimbursement ______ Signed receipt of subsidy collected from participants ______</p><p>\Funding\SAFund\form&guidelines\SAF_form.doc Feb 2014</p><p>5</p>