元智大學社團活動申請服務時數認證表
Yuan Ze University Club Activity Service Hours Certification Application Form
申請日期：年月日
Application Date: Year/Month/Day
申請單位 Applicant Organization | 活動名稱 Event Name | ||||
指導老師 Adviser | 申請人 Applicant | 申請人電話 Applicant's Phone Number | |||
服務地點 Service Location | 服務日期 Service Date (yyy/mm/dd) | 服務時間 Service Hours (00:00~00:00) | |||
認證五育紀錄 Certification of Five Ways of Life | 是Yes 否No | 預估人數 Estimated Number of People | 人 | 申請認證時數 Applied Certification Hours | 時 |
服務學習 (僅能勾選一項並應符合所屬類別) Service Learning Category (Choose only one option that corresponds to the appropriate category) | 活動時數Activity Hours： 社區服務Community Service 愛校服務School Service 勞作服務Labor Service 專業服務Professional Service 深省服務Reflective Service 課程時數Course Hours： 學務課程Student Affairs Course 專業課程Professional Course 通識課程General Education Course 生活勵志Life Inspiration 生涯就業Career and Employment 創業經驗Entrepreneurial Experience. 專業知能Professional Skills 大學適應University Adaptation 衛生保健Health Care | ||||
活動主題 Event Theme | |||||
活動效益 Event Benefits | |||||
課外活動組 Extracurricular Activities Section 審核意見 (申請人勿填) Review Comments (Do not fill in if you are the applicant) | 通 過Approved 不通過，原因Not Approved, Reason： 審核日期Review Date：年(Year) 月(Month) 日(Day) | ||||
填妥此申請表後，連同該活動之企劃書，e-mail給您的社團指導老師。
請至少於活動開始日前兩週提出，以免影響參加活動同學之預選權利。
請轉知參與活動之同學，於「活動前」先至個人portal中選課，並於活動結束後一週內，至系統中填寫服務日誌。
請社長或活動總召於活動結束後一週內，繳交「服務學習課程/活動學員簽到表」給您的指導老師以利評分作業。
1. After completing this application form, along with the event proposal, please email it to your club's adviser.
2. Please submit this application at least two weeks before the start date of the event to ensure the participants' prerogative for pre-selection is not affected.
3. Kindly inform the participating students to enroll in the course through their portal "before the event," and within one week after the event concludes, submit their service learning journals through the system.
4. The club president or event coordinator should submit the "Service Learning Course/Activity Participants' Sign-in Sheet" to your adviser within one week after the event ends to facilitate the grading process.