GTA Chinese Canadian Donations, Community Support and Other Contributions during the COVID 19 Pandemic 多伦多华人社区抗疫期间慈善捐赠、社区援助及其他贡献统计表

GTA Chinese Canadian Donations, Community Support and Other Contributions during the COVID 19 Pandemic 多伦多华人社区抗疫期间慈善捐赠、社区援助及其他贡献统计表
Purpose:
Chinese Canadians have contributed much more than any other community to Canada’s fight against COVID 19, yet not only are our contributions not duly recognized and appreciated, but our community is also frequently attacked by racist groups, individuals and even political leaders. The purpose of this initiative is to collect all the data available, in order to tell the story of our contributions to the mainstream society with facts and numbers, as part of our efforts to counteract anti-Asian racism.

Please fill the form with as much information as possible. Anecdotal stories and details are welcome. Feel free to use Chinese or English, or both.

Please also feel free to explain in the Remarks & Reflections section why you chose to act and make a contribution and leave any comments and reflections you have on what you did.

项目目的：
收集相关的数据和资料，反映加拿大华人对抗击新冠疫情所做出的不为主流大众所知的重大贡献，以此树立和巩固华人作为加国主人翁的正面形象，遏制对华人和东亚族裔的歧视行为。

请尽量填写详细信息，包括各种经历和故事细节，该表格允许您随意扩大表格的空间以填写您想填入的具体信息和资料。您可以选择使用中文、英文或中英文并用。

亦请在“说明与感想”一栏叙述一下您为什么选择在抗疫中出一份力，并留下您做这件事的心得体会。
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 1/5
Organization/Individual Information

Fields marked with an asterisk (*) are mandatory.
Name of Organization/Individual: 机构/个人名称：*
Your Sector 您或机构类别*

Business 私营企业NPO 非赢利机构Community group 社团组织Organized Individuals一群志愿者Individual个人Other
Contact Person: 联系人姓名：*

First NameLast Name
Phone : 联系电话：*
Email: 电子邮件：*
Main Contact Name and Position: 主要联系人姓名和职务：*

First NameLast Name
Phone: 联系电话：*
Email: 电子邮件：*
example@example.com
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 2/5
Contribution Type 贡献性质

Please check all categories that apply 请选择所有符合的选项
Monetary Donation 直接捐款PPE Donation 捐赠防护用品Meal Donation 捐赠餐食Food Donation 捐赠食品Grocery Shopping & Delivery 超市代购Education/Information Sharing 信息分享/普及Mental Health Support 情感支持Other (Please specify) 其他 (请具体说明)
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 3/5
Monetary Donation 直接捐款
Donation Type*

With yours or your organization’s own funds 个人或机构独立出资捐款With raised funds 筹款捐款
With yours or your organization’s own funds

个人或机构独立出资捐款
Donation Amount: 捐款金额：CAD$*
e.g. 200
Donee: 捐赠对象：*
Donation Date: 捐赠日期：*
If applicable,you can write all the dates. e.g. April 5, 2020; June 14, 2020
If you have donated to more than one donee, please click Yes to add more: 如有捐赠更多对象，请点击Yes加更多:

Yes
Donation Amount: 捐款金额：CAD$*
e.g. 200
Donee: 捐赠对象：*
Donation Date: 捐赠日期：*
If applicable,you can write all the dates. e.g. April 5, 2020; June 14, 2020
If you have donated to more than one donee, please click Yes to add more: 如有捐赠更多对象，请点击Yes加更多:

Yes
Donation Amount: 捐款金额：CAD$*
e.g. 200
Donee: 捐赠对象：*
Donation Date: 捐赠日期：*
If applicable,you can write all the dates. e.g. April 5, 2020; June 14, 2020
Total Amount: 捐款总金额：CAD$*
e.g. 200
Remarks & Reflections: 说明与感想：
With raised funds

筹款捐款
Donation Amount: 筹款金额：CAD$*
e.g. 200
Donee: 捐赠对象：*
Donation Date: 捐赠日期：*
If applicable,you can write all the dates. e.g. April 5, 2020; June 14, 2020
If you have donated to more than one donee, please click Yes to add more: 如有捐赠更多对象，请点击Yes加更多:

Yes
Donation Amount: 筹款金额：CAD$*
e.g. 200
Donee: 捐赠对象：*
Donation Date: 捐赠日期：*
If applicable,you can write all the dates. e.g. April 5, 2020; June 14, 2020
If you have donated to more than one donee, please click Yes to add more: 如有捐赠更多对象，请点击Yes加更多:

Yes
Donation Amount: 筹款金额：CAD$*
e.g. 200
Donee: 捐赠对象：*
Donation Date: 捐赠日期：*
If applicable,you can write all the dates. e.g. April 5, 2020; June 14, 2020
Amount　Raised: 筹款总额：CAD$*
e.g. 1000
Remarks & Reflections: 说明与感想：
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 3/5
PPE Donation 捐赠防护用品
Donation Type*

With yours or your organization’s own funds 个人或机构独立出资捐赠With raised funds 筹款捐赠Self-made PPE自己制作防护用品
With yours or your organization’s own funds

个人或机构独立出资捐赠
Please List all donation details(Donee/Date/PPE Name/PPE Amount) ：请列出捐赠细节(捐赠对象/日期/防护用品名称/用品数量):*
e.g.1.2020.3.1 donated 500 of N95 masks to XX Hospital 2.2020.3.5 donated 300 of N95 masks to YY Hospital 例如: 1.2020年3月1日捐赠500个N95口罩给XX医院 2.2020年3月5日捐赠300个N95口罩给YY医院
Total amount spent：花费总额：CAD$*
e.g. 200
Remarks & Reflections：说明与感想：
With raised funds

筹款捐赠
Please List all donation details(Donee/Date/PPE Name/PPE Amount) ：请列出捐赠细节(捐赠对象/日期/防护用品名称/用品数量):*
e.g.1.2020.3.1 donated 500 of N95 masks to XX Hospital 2.2020.3.5 donated 300 of N95 masks to YY Hospital 例如: 1.2020年3月1日捐赠500个N95口罩给XX医院 2.2020年3月5日捐赠300个N95口罩给YY医院
(Estimated)AmountRaised: (预计)筹款总额：CAD$*
e.g. 1000
Remarks & Reflections 说明与感想：
Self-made PPE

自己制作防护用品
Please List all donation details(Donee/Date/PPE Name/PPE Amount) ：请列出捐赠细节(捐赠对象/日期/防护用品名称/用品数量):*
e.g.1.2020.3.1 donated 500 of N95 masks to XX Hospital 2.2020.3.5 donated 300 of N95 masks to YY Hospital 例如: 1.2020年3月1日捐赠500个N95口罩给XX医院 2.2020年3月5日捐赠300个N95口罩给YY医院
Total Number of people involved：参与总人数：*
e.g. 100
Total Time Spent：花费总时间：*
e.g. 1000
Estimated total cost：产品总花费： CAD$*
e.g. 1000
Remarks & Reflections: 说明与感想：
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 3/5
Meal Donation 捐赠餐食
Meal type (lunch, dinner, ) 餐类（午餐，晚餐）：*
Place/people donated to：被供餐机构/人群：*
Number of meal packages per day：日供份数：*
e.g. 100
Start date：起始日期：*

MonthDayYear
Date
End Date：结束日期：

MonthDayYear
Date
Subtotal of meals donated: 供餐总数：
e.g. 1000
Subtotal of estimated value of meals：供餐价值：CAD$
e.g. 1000
If you have donated to more than one donee, please click Yes to add more: 如有捐赠更多机构，请点击Yes加更多:

Yes
Meal type (lunch, dinner): 餐类（午餐，晚餐）：*
Place/people donated to：被供餐机构/人群：*
Number of meal packages per day：日供份数：*
e.g. 100
Start date：起始日期：*

MonthDayYear
Date
End Date：结束日期：

MonthDayYear
Date
Subtotal of meals donated：供餐总数：
e.g. 1000
Subtotal of estimated value of meals: 供餐价值：CAD$
e.g. 1000
If you have donated to more than one donee, please click Yes to add more: 如有捐赠更多机构，请点击Yes加更多:

Yes
Meal type (lunch, dinner): 餐类（午餐，晚餐）：*
Place/people donated to：被供餐机构/人群：*
Number of meal packages per day：日供份数：*
e.g. 100
Start date：起始日期：*

MonthDayYear
Date
End Date：结束日期：

MonthDayYear
Date
Subtotal of meals donated：供餐总数：
e.g. 1000
Subtotal of estimated value of meal：供餐价值：CAD$
e.g. 1000
Total meals donated：累计供餐总数：*
e.g. 1000
Total estimated value of meals累计供餐总价值：CAD$*
e.g. 1000
Remarks & Reflections: 说明与感想：
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 3/5
Food Donation 捐赠食品
Value of food donated：捐赠食品总价值：CAD$*
e.g. 1000
Foodbank donated to：受益食物银行：*
Types and amounts of food donated：捐赠食品种类及数量：
Remarks & Reflections：说明与感想：
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 3/5
Grocery Shopping & Delivery 超市代购
Name of initiative (if applicable) 活动名称（如有）：
Number of volunteers mobilized：义工人数：*
e.g. 100
Number of families helped：受助家庭数：
e.g. 100
Number of people helped：受助总人数：
e.g. 100
Number of return trips made：驾车来回趟数：
Geographic area covered：服务地区范围：
Start date of mobilization：活动开始日期：*

MonthDayYear
Date
End date of initiative：活动结束日期：

MonthDayYear
Date
Remarks & Reflections: 说明与感想：
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 3/5
Education/Information Sharing 信息分享/普及
Name of initiative (if applicable)：活动名称（如有）：
Main activities：活动描述：
Number of volunteers：义工人数：*
e.g. 100
Target audience: 服务对象：*
Number of participants/people reached/people informed：受益人数：
e.g. 100
Geographic area covered ：服务地区范围：
Number of people helped: 受助总人数：
e.g. 100
Start date of mobilization：活动开始日期：*

MonthDayYear
Date
End date of initiative：活动结束日期：

MonthDayYear
Date
Remarks & Reflections ：说明与感想：
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 3/5
Mental Health Support 情感支持
Name of initiative (if applicable)：活动名称（如有）：
Main activities：活动描述：*
Number of volunteers：义工人数：*
e.g. 100
Number of people assisted：受助总人数：
e.g. 100
Geographic area covered: 服务地区范围：*
Start date：活动开始日期：*

MonthDayYear
Date
End date：活动结束日期：

MonthDayYear
Date
Remarks & Reflections：说明与感想：
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 3/5
Other（Please specify ）其他（请具体说明）
Name of initiative 活动名称：*
Main activities 活动描述：
Recipients of contribution 受益人/机构*
e.g. 100
Value of contribution：贡献的价值：*
e.g. 100
Cost involved：成本：
e.g. 100
Number of volunteers：义工人数：
e.g. 100
Number of days/hours volunteered：义工天/小时数：
e.g. 100
Number of people benefited：受益人数：
e.g. 100
Geographic area covered：服务地区范围：
Start date：活动开始日期：

MonthDayYear
Date
End date：活动结束日期

MonthDayYear
Date
Remarks & Reflections：说明与感想：
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 4/5
Optional Documents
Please upload relevant files, pictures and videos of your activities.（optional）：请上传有关照片、视频、资料。

Upload a File

Cancelof
More upload：

Upload a File

Cancelof
More upload：

Upload a File

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Please provide links to media reports of your activities：请提供有关媒体报道的链接：
Donation Date: 捐赠日期：

MonthDayYear
Date
Additional comments and suggestions: 其他信息、评论、建议：
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Step 5/5
Declaration
In order to submit this survey, you must review and acknowledge that by clicking yes, you agree to the following:
- I certify that all information and documents provided are true and accurate to the best of my knowledge.
If you have any concerns, call CPAC’s office at (416) 298-7885 or email to office@cpac-canada.ca. For more information about CPAC, please visit: https://www.cpac-canada.ca/.
Please verify that you are human*
Yes
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。

Are you ready to submit?

是否提交？
Note: You will receive a link through email and can modify your form after submission.

特别提示：提交表格后，您将会收到表格链接，如有任何遗漏或补充，可以做再次修改。
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GTA Chinese Canadian Donations, Community Support and Other Contributions during the COVID 19 Pandemic 多伦多华人社区抗疫期间慈善捐赠、社区援助及其他贡献统计表

Organization/Individual Information

Contribution Type 贡献性质

Monetary Donation 直接捐款

PPE Donation 捐赠防护用品

Meal Donation 捐赠餐食

Food Donation 捐赠食品

Grocery Shopping & Delivery 超市代购

Education/Information Sharing 信息分享/普及

Mental Health Support 情感支持

Other（Please specify ） 其他（请具体说明）

Optional Documents

Declaration

Other（Please specify ）其他（请具体说明）