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1. Organisation Name 機構名稱

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2. Name of Main Contact Person 聯絡人姓名

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3. Designation 職位

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4. Email 電郵

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5. Mobile 聯絡電話

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6. Please describe your COVID 5th Wave related fundraising campaign in 50 words: 
請用50字簡述貴機構所發起有關第五波疫情捐款或捐贈呼籲：

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7. Please share below the link to your COVID 5th Wave fundraising campaign if applicable:
請提供上述捐款或捐贈呼籲的網站鏈結：
(如您的捐款或捐贈呼籲沒有網站鏈結，請輸入"NA")

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8. Please describe how the donation will be used :
eg. HKD10,000 will buy XX blankets / XX lunchboxes / XX PCR self test kits
請說明貴機構會如何使用捐款：
（例如：會用一萬元港幣買 XX張棉被/ XX 午餐 / XX 新冠快速抗原檢測包）

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9. How many beneficiaries will be served by a donation of :
(eg. 50 people / 100 people / 500 people) 
捐款將幫助多少位服務對象：
（例如：50人 / 100人 / 500 人）

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10. What type of beneficiaries will you serve with the funds? (Please choose all that apply)
以下哪些服務對象將會受到捐款的幫助？(可選擇多於一項)

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11. Over what period of time will you apply the donation for the benefit of the service users? (eg. over XXX weeks from receiving the donation) 
貴機構將於甚麼時間段內將捐款用於服務對象？（例如： 從收到捐款的XX星期內）

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12. Is there any other information you would like to share with prospective funders ? 您還有其他資訊想與潛在資助者分享嗎？

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13. Do you agree to share the replies to the questions above on the ACS online Community Support Platform?
您是否同意於ACS的Community Support Platform分享以上所有問題的內容？

 
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