Co-organised by Home Affairs Bureau and Commission on ... - Cedars

「 2013 年大型青年活動資助計劃」
簡介會 – 報名表格
日期: 2013 年 2 月 7 日(星期四)
時間: 上午 11 時正
地點: 香港銅鑼灣福蔭道 7 號
銅鑼灣社區中心
報名手續:
1. 請填妥報名表格,並於 2013 年 2 月 5 日或之前傳真至青年事
務委員會秘書處(傳真:2591 6002)。 請勿重覆登記。
2. 我們會於 2013 年 2 月 6 日或之前將印有順序號的報名表格傳
真予貴機構。
3. 請攜同印有順序號的報名表格出席簡介會。
4. 因座位有限,每個申請單位請盡量安排最多兩位代表出席。
團體:
單位:
出席者: 職銜:
電郵:
電話:
傳真號碼:
團體印鑑:
順序號: 青年事務委員會
蓋印
(由青年事務委員會秘書處填寫)

# 請在適當方格內加上“ ” 號。 Please “” the appropriate box.
申請編號
Application No.
民政事務局與青年事務委員會合辦
<strong>Co</strong>-<strong>organised</strong> <strong>by</strong> <strong>Home</strong> <strong>Affairs</strong> <strong>Bureau</strong> <strong>and</strong> <strong>Co</strong>mmission on Youth
2013 年大型青年活動資助計劃申請表格
Application Form for the Large-scale Youth Programme Funding Scheme 2013
(此欄由秘書處填寫 For official use only)
(請遞交:申請表的正本、影印本、MS Word 格式軟複本各一份,以及一張光碟內含簡報檔案以簡介申請活動*)
(Please submit: Original copy, a photocopy, a soft copy in MS Word format of the application form, <strong>and</strong> a CD-ROM consisting of the programme brief in ppt file*)
甲部 – 申請團體資料 Section A – Particulars of Applicant Organisation
1. 申請團體名稱
Name of Applicant Organisation _______________________________________________________________________________________________
2. 單位 Unit _______________________________________________________________________________________________
(請附上團體的註冊或證明文件副本。Please attach a copy of the organisation’s registration document / proof of status.)
3. 慈善團體
Charitable organisation
# □ 是 Yes (請夾附根據《稅務條例》第 88 條獲豁免繳稅的證明文件副本。)
□ 否 No
(Please attach a copy of document certifying the charitable institution is exempt from tax under
section 88 of the Inl<strong>and</strong> Revenue Ordinance.)
4. 團體簡介 _______________________________________________________________________________________________
Brief description of the _______________________________________________________________________________________________
Organisation _______________________________________________________________________________________________
5. 團體網址
Website of the Organisation _______________________________________________________________________________________________
6. 過去三年籌辦青年活動,尤其是大型活動的經驗
Experience in organising youth activities in the past three years, in particular for large scale youth activities
活動名稱
Name of activities
日期
Dates
內容簡介
7. 貴機構於 2012-13 年度曾否在「大型青年活動資助計劃」獲批撥款?
Brief description of the activities
Has your organisation been granted funding under “Large-scale Youth Programme Funding Scheme" in 2012-13?
參與人數
No. of participants
□是,我們曾於 2012-13 就_____________(活動名稱)獲批撥款,實際資助額合共港幣_________________(實際資助額)。
Yes, we were granted ____________________(actual amount of sponsorship) in 2012-13 for _____________________ (name of activity).
□否 No
備註
Remarks
* 申請機構須提交光碟一張,內含不多於 12 頁的簡報(Powerpoint)以簡介申請活動,供評審小組考慮。簡報內容須包含
活動內容簡介、在推動青年發展上的預期成效、活動的規模、技術可行性、及財務可行性。Applicants are required to
submit a CD-ROM consisting of a programme brief of not more than 12 pages presented in Powerpoint for Assessment
Panel’s consideration. The brief should include a brief introduction of the programme, its expected effects in
promotion of youth development, its scale as well as its technical <strong>and</strong> financial feasibility.

乙部 – 活動計劃概要 Section B – Project Overview
8. 活動計劃名稱
# 請在適當方格內加上“ ” 號。 Please “” the appropriate box.
申請編號
Application No.
(此欄由秘書處填寫 For official use only)
Project name _____________________________________________________________________________________________
9. 活動目標
Project mission _____________________________________________________________________________________________
10. 活動理念
Project rationale _____________________________________________________________________________________________
11. 活動內容 _____________________________________________________________________________________________
Project description _____________________________________________________________________________________________
12. 活動舉辦後的預期成效 _____________________________________________________________________________________________
Anticipated outcome of _____________________________________________________________________________________________
the Project _____________________________________________________________________________________________
13. 活動曾否於過去舉辦?
Has the Project been held before?
# □是,已舉行了___屆,上一屆參與人數共_________人
Yes, it has been run for __________ times. Total number of participants last round was
________________
(請回答第 14 題 Please answer Question 14.)
14. 承第 13 題,如活動曾於過去舉辦,上一屆的經費來源是甚麼?
Further to Question 13, if the Project has been held before, where did the resources come from in last round?
收入項目 Item of income 數額(元) Amount ($)
向參加者收取的費用 Fees to be collected from participants
($______元 x ______)
申請團體自行承擔的開支 Provision from the applicant organisation
贊助 Sponsorship
(請列明贊助機構名稱及金額 Please specify the sponsoring organisations <strong>and</strong> amounts)
總額 Total
15. 舉行日期 Date(s)* _________________________ 14. 地點 Venue ___________________________
□否 No
* 活動必須於 2013 年 6 月至 2015 年 5 月期間舉行及完成 The Project should be held <strong>and</strong> completed during the period June 2013 <strong>and</strong> May 2015.
16. 活動對象
Target group
17. 活動規模
Project scale
# □ 小學生
Primary School students
□ 在職青年 (至 29 歲)
Working Youths
(up to 29 years old)
# □ 本地青年活動
Local Youth Event
□ 中學生
Secondary School students
□ 非純本地青年活動
Non-local Youth Event
□ 大專或以上學生
Students of tertiary education

預計人數
Estimated no. of persons
18. 參加者報名形式
Enrollment for participants
19. 觀眾報名形式
Enrollment for audience
20. 宣傳計劃
Publicity plan
# 請在適當方格內加上“ ” 號。 Please “” the appropriate box.
申請編號
Application No.
如屬非純本地青年活動,請列明: (i) 參與國家/地區數目:_________
(此欄由秘書處填寫 For official use only)
(ii) 參與國家/地區:____________________
(iii) 預計本地參與人數:_________
(iv) 預計來自內地、澳門及台灣參加者的總人數:_________
(v) 預計來自其他國家參加者的總人數:_________
For non-local youth events, please specify: (i) the number of participating nations/regions: _________
本地
6-29 歲青年參加者
Youth participants aged 6 to 29
Hong Kong
內地、澳門 其他國家
及台灣
Mainl<strong>and</strong>,
Macao <strong>and</strong>
Taiwan
# □ 公開免費招募
Other
<strong>Co</strong>untries
Open enrollment (free of charge)
# □ 公開免費派發門票
Free public distribution of
tickets
□ 無需門票 Tickets not required
(ii) participating nations/regions:_________________________________
(iii) the number of Hong Kong participants: ______
(iv) the total number of participants coming from Mainl<strong>and</strong> China,
Macao <strong>and</strong> Taiwan: ______
(v) the total number of participants coming from other countries: ______
本地
Hong Kong
□ 公開售票
其他參加者
Other participants
內地、澳門 其他國家
及台灣
Mainl<strong>and</strong>,
Macao <strong>and</strong>
Taiwan
Open for ticketing
□ 公開售票
Open for ticketing
Other
<strong>Co</strong>untries
本地
Hong Kong
觀眾
Audience
內地、澳門 其他國家
及台灣
Mainl<strong>and</strong>,
Macao <strong>and</strong>
Taiwan
□ 只限個別獲邀之人士或團體
(請註明:____________)
By invitation
(Please specify:______)
□ 只限個別獲邀之人士或團體
(請註明:____________)
By invitation
(Please specify:______)
Other
<strong>Co</strong>untries
________________________________________________________________________________
___________________________________________
21. 活動的籌備工作時間表 ________________________________________________________________________________
Schedule for the Project preparation works ________________________________________________________________________________
22. 活動成效評估方法 ________________________________________________________________________________
Method of performance assessment ________________________________________________________________________________

23. 青年人在籌備工作中的參與
Involvement of youths in the Project preparation
24. 活動的其他特色
# 請在適當方格內加上“ ” 號。 Please “” the appropriate box.
申請編號
Application No.
(此欄由秘書處填寫 For official use only)
___________________________________________________________________________
_________________________________________________________________________
Other Features of the Project
___________________________________________________________________________
(如屬聯校或跨團體活動,請在此列明參加的學校及團體
__________________________________________________________________________
For joint-school or inter-organisation activities, please
__________________________________________________________________________
specify participating schools <strong>and</strong> organisations)
(可另附頁 Please attach supplementary sheets if required)
丙部 –活動預算 Section C – Project Estimates
25. 活動預算支出 Estimated Expenditure
26. 活動預計收入 Estimated Income of the Project
支出項目
Expenditure item
總額 Total:
收入項目 Item of income 數額(元) Amount ($)
向參加者收取的費用 Fees to be collected from participants
($______元 x ______)
申請團體自行承擔的開支 Provision from the applicant organisation
其他已確定的贊助 Other confirmed sponsorship
(請列明贊助機構名稱及金額 Please specify the sponsoring organisations <strong>and</strong> amounts)
其他有待落實/擬申請的贊助 Other sponsorship pending approval/ to be applied
(請列明贊助機構名稱及申請中/擬申請的贊助金額 Please specify the sponsoring organisations <strong>and</strong> amounts
under application/ to be applied)
27. 擬向委員會申請的資助額(元)^
總額 Total
Amount of sponsorship sought from the <strong>Co</strong>mmittee ($) ________________________________
^ 申請資助額不多於總開支的 50%
預算支出 (元)
Estimated Expenditure($)

丁部 - 聲明 Section D – Declaration
1. 本申請表內提及的活動為非牟利,且並非為個人或團體作政治、宗教或商業宣傳。
# 請在適當方格內加上“ ” 號。 Please “” the appropriate box.
申請編號
Application No.
(此欄由秘書處填寫 For official use only)
All the proposed activities are non-profit-making <strong>and</strong> will not be used for political, religious or commercial publicity for any individual or organisation.
2. 本團體明白並同意遵守本資助計劃章程內所列的條款。如獲委員會資助,本團體會遵守資助計劃“使用撥款守則”內訂明的各項規定。
We underst<strong>and</strong> <strong>and</strong> agree to abide <strong>by</strong> the terms <strong>and</strong> conditions of this Scheme. We will comply with all the requirements laid down in the “Guidelines on
the Use of Sponsorship” under the Scheme should we be granted sponsorship for the project.
團體負責人 Person-in-charge of the Organisation
(負 責監管活動計劃 Responsible for overseeing the project)
活動計劃負責人 Person-in-charge of the Project
(負 責推行活動計劃 Responsible for implementing the project)
姓名 Name # □先生Mr._____________________________ 姓名 Name □先生Mr. .____________________
□女士Ms. .____________________________ □女士Ms. .___________________
職位 Post 職位 Post
團體地址 Address 聯絡電話 Tel. No.
簽署 Signature
日期 Date
註:申請人提供的個人資料只作處理本申請之用。
傳真號碼 Fax No.
電郵地址 Email Address
簽署 Signature
團體印章
Official Seal
Note: Personal data provided <strong>by</strong> the applicant will be used for processing this application only.