Inclusive Activity Fund - Reimbursement Request

SEN Service, Wellness and Counselling Centre, Office of Student Affairs

Please complete this reimbursement form and upload the following within 10 working days after completion of the activity:
a. Promotional materials for the activity (including, but not limited to posters and emails)
b. At least 5 photos taken during the activity
c. Attendance records with participants’ name, CUHK student ID/ staff ID, and participants’ signatures
d. Results/ statistics of post-activity evaluation
e. Copies of proof of payment for the expenses incurred
● (For internal units) copies of receipts and any associated credit card statements for online purchases
● (For student groups) electronic receipts and associated credit card statements for online purchases; any hard-copy receipts must be submitted to SENS (Office address: Room 311, 3/F, Pommerenke Student Centre, CUHK)

Enquiries: 3943 5441 / sens@cuhk.edu.hk

Last updated: Nov 2024

1. Applicant Category

1. Applicant Category CUHK College/Department/Unit Student Organization/Society/Interest Group Registered/Affiliated with OSA Informal Student Group
2. Name of Responsible Staff/ Principal Coordinator for Student Group (in English) 2. Name of Responsible Staff/ Principal Coordinator for Student Group (in English) First Last
3. Affiliated College/Department/Unit
3. Student Group Name
4. Contact Number
5. Email Address
Activity Details
6. Activity Name
7. Date(s) & Time
8. Venue(s)
9. Number of People Enrolled
10. Total Number of Participants
10a. Number of CUHK Staff Participants
10b. Number of CUHK Full-time Student Participants
11. Total Amount of Expenses (HK$)
12. Total Funding Required from SENS (HK$):

Should be equivalent to the actual amount of expenses or the funding cap of HK$6,000, if actual expenses exceed HK$6,000
13. Please upload promotional materials for the activity (including, but not limited to posters and emails).

Attach Files
14. Please upload at least 5 activity photos.

Attach Files
15. Please upload the attendance records with participants’ name, CUHK staff ID/full-time student ID, and participants’ signatures.

Attach Files
16. Please upload the results/statistics of post-activity evaluation with questions that indicate 1. the overall satisfaction and 2. the increase of SEN awareness on a 6-point scale.

Attach Files
17. Please submit copies of receipts as one PDF document here.

Attach Files

If there were online purchases, please also submit copies of credit card statements associated with the payments.
18. Are there any electronic receipts?

18. Are there any electronic receipts? Yes No

If electronic receipts are the only proof of payment. please select 'Yes'.

For hard-copy receipts, please send the original receipts to SENS (3/F, Pommerenke Student Centre, CUHK) by internal mail/post/hand.
18a. Please attach the electronic receipts as PDF here.

Attach Files

For purchases settled by credit cards, please also attach the credit card statement displaying the proof of transaction - please hide all other personal information as appropriated.
18b. Sum of Expenses in All Electronic Receipts Uploaded (HK$)
18c. Sum of Expenses in All Hard-copy Original Receipts to be Submitted to SENS (HK$)

Input '0' if not applicable
Disbursement Information

(For student organizations/ groups only)
19. Bank Account Holder Name
20. Bank Name
21. Bank Account Number
22. Copy of Bank Card/Statement with the Bank Account Information

Attach Files
Disclaimer The personal data collected will be used by SEN Service (SENS) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.

Inclusive Activity Fund - Reimbursement Request

Activity Details

Disbursement Information