SEN Service - Registration Form for Rehabus (Eligible Users with Temporary Injuries Only)

Day Service Eligibility (in the order of priority):
● Full-time students with temporary injuries as endorsed by the University Medical Service Office (UMSO)
● Full-time/ part-time staff with temporary injuries as endorsed by UMSO

Students/ staff with temporary injuries:
● A confirmation email will be sent to you once your registration is successfully processed
● Once registered, eligible users may start booking via the Online Booking Form:
https://cloud.itsc.cuhk.edu.hk/webform/view.php?id=13671106

1. Full Name in English 1. Full Name in English * First Last
2. Full Name in Chinese 2. Full Name in Chinese First Last
3. Contact Phone No. *
4. Email Address (CUHK Email Address is Preferred.) *
5. Identity *

5. Identity Full-time CUHK Student CUHK Staff
6. Student ID *
Must be 10 digits. Currently Entered: 0 digits.
6. Staff ID *
6a. Employment Mode *

6a. Employment Mode Full-time Part-time
7. Please upload the endorsement from the University Medical Service Office (UMSO) *

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.