Application Form for Yang Tuck Ming & Wong Fung Ying Service Learning Fund (2024-2025 First Semester)

(A) Information of Project Team

1. Project Coordinator

Title

Surname

Other Name

Name in Chinese (if applicable)

Mobile No.

HKU Email Address (must provide)

Please provide your HKU email address and CEDARS will communicate with you using this HKU email address.

Personal Email Address

Please provide another personal email address which you check frequently.

University Number

Faculty

Level of Study

Year of Study

Curriculum (e.g. BEng (CivE-Law), BBA (Acc&Fin), BSc (Actuar Sc), BSS (GL)&LLB, etc.)

Nationality

2. Other Core Team Members from HKU

Please provide information of a maximum of three core team members

Please state their (1) Full Names, (2) Curriculum (3) Year of Study, (4) Mobile Numbers, and (5) Email Addresses in the text box.

3. Faculty Advisor from HKU

Title

Surname

Other Name

Faculty

Job Title

Phone Number

Email Address

(B) Project Information

Project Title

Student Group / Club / Society

Website (if any)

Facebook (if any)

Email Address (if any)

Location of the Project

Expected Start Date

Expected Completion Date

Project Summary (150 words)

Project Objectives (150 words; can be in point form)

Expected Outcomes of the Project (200 words; can be in point form)

Expected Number of HKU Participants

1. Local HKU students: *

Undergraduates

Postgraduates

2. Full-time full-degree non-local HKU students: *

For service trips out of Hong Kong, the Fund can be used to cover the traveling and accommodation costs of full-time local HKU students.

Undergraduates

Postgraduates

3. Total number (1+2)

Type and Number of Service Targets

Example: 1. Primary school students (50) 2. Teachers (10) 3. Parents (50)

Is the project credit-bearing?

Yes

Name of External Partner Organisation(s)

Website of External Partner Organisation

Name of Responsible Staff

Position of Responsible Staff

Phone Number

Email Address

Details of any involvement or relationships of the project co-ordinator, student participants and Faculty Advisor with the external partner organisation(s)

(Please explain the type and duration of involvement or relationships, if any. If there is no such involvement or relationship, please put “Nil” in the box).

(D) Project Proposal

Please upload the project proposal including the budget and tentative itinerary of service trips outside Hong Kong (if any) according to the requirements..

For details on the requirement of proposal, please refer to Part D on website (http://cedars.hku.hk/Y-WSLFund).

One file only.
8 MB limit.
Allowed types: pdf, doc, docx, rar, zip.

(E) Amount of Grant Applied for

Please state the amount of grant applied for *HK$

(F) Background information of student society / group

Please upload a one-page background information of your student society / group

One file only.
8 MB limit.
Allowed types: gif, jpg, png, pdf, doc, docx, zip.

(G) CV(s) of Project Coordinator(s)

Please upload the CVs of project coordinator(s)

One file only.
8 MB limit.
Allowed types: gif, jpg, png, pdf, doc, docx, ppt, pptx, zip.

(H) Supplementary Information

You can upload other relevant supplementary information with no more than 6 pages.
One file only.
8 MB limit.
Allowed types: gif, jpg, png, pdf, doc, docx, xls, xlsx, rar, zip.

(I) Declaration

I confirm that all information given in this application is correct, complete and true to the best of my knowledge.

I confirm that all changes to approved proposal, budget and completion dates require approval by CEDARS in advance.

I confirm that I have to disclose any other funding source(s) for supporting the project, or I will risk the withdrawal of any approved grant from the Fund.

I confirm that I have consulted the Faculty Advisor and Partner Organisation(s) to identify and address any risks relating to undertaking this project.

I confirm that the project in this application is non-credit-bearing.

I confirm that all students supported by the Fund to participate in any out-of-Hong Kong trip(s) are required to sign the Assumption of Risk and Release Form (downloadable at www.cedars.hku.hk/releaseform) and return the signed copies to CEDARS by email to mlleung@hku.hk at least 14 working days before the date of departure from Hong Kong. Failure to do so may result in disqualification of the Fund.

I understand that my project team has the right to request access to, correction and withdrawal of our personal data and related information by writing to CEDARS.

(J) Personal Information Collection Statement and Privacy Policy Statement

The information collected will be used for the assessment and reporting purpose of Yang Tuck Ming & Wong Fung Ying Service Learning Fund administered by CEDARS. CEDARS is committed to meeting internationally-recognised standards of personal data privacy protection, in compliance with the requirements of the Personal Data (Privacy) Ordinance. In doing so, it will be ensured that staff comply with the strictest standards of security and confidentiality.

I have read and agree to the above conditions.

Name of Applicant (in full name)

Name of Project Team (student group or society):

Date