冼柏华纪念基金申请表.doc

冼柏華紀念基金申請表 Thomas Sin Memorial Fund Application Form Programme Information 舉辦單位 Organizing Unit 活動編號 Programme Index 活動名稱 Programme Name 活動舉行日期 Programme Period 至 To 申請資助款額 Apply for Subsidies Amount ( 全額津貼 Full Grant ( 半額津貼 Half Grant 港幣$ HKD$ 申請人資料 Applicant Information 英文姓名 Name in English 中文姓名 Name in Chinese 出生日期 Date of Birth (日 / 月 / 年 ) (DD / MM / YYYY) 所屬總部 / 工作單位 Division/Working Unit 會員藉 Membership 團隊編號 Unit No. 會員編號 Membership No. 學校名稱 Name of School 申請者是否曾透過「冼柏華紀念基金」取得資助? Did you receive subsidies from「Thomas Sin Memorial Fund」before? ( 是 Yes ( 否 No 申請者是否獲得其他資助參與是次交流活動？ Did you receive other funding sources to support the exchange program? ( 是 Yes ( 否 No 如有，請列明 If yes, please specific 資助機構 / 單位 Funding Body / Unit 資助款額 Subsidies Amount 港幣$ HKD$ 申請人聲明 Applicant Declaration 本人 已詳閱填寫「冼柏華紀念基金」申請表注意事項，並完全明白所有內容。 本人謹此聲明： I, have read and fully understood the Guidance Notes on Filling in the application for the「Thomas Sin Memorial Fund」 for Junior/Youth Members of Hong Kong Red Cross. I would like to make the following declarations: 本人明白及確認上述申請者現時並沒有接受其他機構/單位的資助或支援服務 I understand and confirm the applicant is not currently receiving subsidies/services provided by other agencies / unit. 本人承諾提供正確資料及沒有隱瞞任何事項，絕不會錯誤引導批核單位以圖獲得資助 I undertake to provide true information and not to withhold any information. I will absolutely not mislead the approved authority for the purpose of obtaining subsidies. 本人接納及尊重批核單位所訂立的評審準則，及接受批核單位的最後決定 I agree to and respect the assessment criteria of approved authority and I am willing to accept its final decision. 申請人姓名 Name of Applicant 申請人簽署 Signature of Applicant 日期 Date 家長或監護人姓名 Name of Parent/Guardian 家長或監護人簽署 Signature of Parent/Guardian 日期 Date 冼柏華紀念基金申請表 Thomas Sin Memorial Fund Application Form“(” as appropriate) ( 申請人的家庭正領取綜合社會保障援助 The applicant receives Comprehensive Social Security Assistance. ( 申請人獲學生資助計劃全額津貼 The applicant receives full grant under the Student