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# 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
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