2015-16 Hong Kong Outstanding Youth Volunteers Scheme

Organizer / : / Steering Committee on Promotion of Volunteer Service
Social Welfare Department
Partner Organization / : / Hong Kong Outstanding Youth Volunteers’ Association

Application Form

Applicant should complete the form prior Referee’s signature

Grouping:

 / Group 1 (Aged 16-19)
 / Group 2 (Aged 20-24)
1. / Particulars of applicant:
Name: / (Chinese)
(English)
(should be the same as shown in HKID card)
I.D. Card No.: / Sex: /  M /  F
Date of birth: (D/M/Y) / Age:
Corresponding address: / (Chinese)
(English)
Tel. No. / E-mail:
(in BLOCK Letter)
Highest Education level and Subjects:
(Highest Education level) / (Subjects)
Issuing Institution / School:
 / In School
Name of School:
Class and Subject
(Class) (Subjects)
 / In Employment
Occupation:
Employer
 / Pending Job
2. / Volunteering Experiences
Years of Volunteer Services: / Total Service Hours in past 5 years: (including the time spent on planning, direct service and evaluation)
 / 3 – 4 years /  / 200 – 249 Hours
 / 5 – 9 years /  / 250 – 499 Hours
 / 10 years or above /  / 500 – 999 Hours
 / 1000 Hours or above
3. / Participation and commitment in volunteer service
(in chronological order starting from the most recent one with maximum of 10 items)
Date/
duration / Name of service
project / Nature and type of service / Service hours# / Service target / Organizer / Degree of participation*
1 / 2 / 3 / 4
1 / 2 / 3 / 4
1 / 2 / 3 / 4
1 / 2 / 3 / 4
1 / 2 / 3 / 4
1 / 2 / 3 / 4
1 / 2 / 3 / 4
1 / 2 / 3 / 4
1 / 2 / 3 / 4
1 / 2 / 3 / 4

# Service hours: including the time spent in planning, direct service and evaluation.

* Degree of participation: 1) Advocator/ Founder 2) Planner and Organizer 3) Associate Organizer 4) Assistant in Programme Implementation (can circle more than one)

4. / Experiences in planning and/or organizing volunteer service projects : Please state up to 3 important projects in chronological order, starting from the most recent one:
a. / Name of Projects:
Date of Service: / Duration: / Target:
No. of Beneficiaries: / No. of Volunteers you led and
cooperated with:
Objective:
Brief Service Content:
b. / Name of Projects:
Date of Service: / Duration: / Target:
No. of Beneficiaries: / No. of Volunteers you led and
cooperated with:
Objective:
Brief Service Content:
c. / Name of Projects:
Date of Service: / Duration: / Target:
No. of Beneficiaries: / No. of Volunteers you led and
cooperated with:
Objective:
Brief Service Content:
5. / Language skills: /  English /  Cantonese /  Putonghua /  Others / (Please specify)
6. / Other special skills/expertise: / (Please pecify)
7. / Reflection gained in volunteer experience: (Please limit your words to 500 in English. Please add separate sheets if space is not enough.)
8. / Awards received on volunteer services (Individual / Organization)

(Please state the important awards up to 5)

Year / Name of Award
(please indicate whether the awards is on individual or organizational basis) / Issuing Organizations

(Proof of awards is not required to be submitted at present stage.)

9. / The participated exchange activities : (please state up to 5)
Date / Main Organizations / Destination of Exchange

Copies of documents/certificate/awards are not required to be submitted with the application form. Applicants should submit the true copy and provide photocopy of all documents mentioned in the application form after he/she is selected as the candidates of the Scheme. The Selected youth volunteers will be disqualified when the organizer find to have discrepancy between the reported information and submitted documents.

I declare that the information stated above is true and correct. I have read thoroughly the regulations for the Scheme and agreed unanimously to follow it laid down by the organization.

Signature of Applicant:
Date:
10. / Referee’s comments (Please limit to 400 words in English or Chinese, add separate sheets if required)
11. / Particulars of Referee
Name: / (Mr. / Ms.)
Name of organization: / Post:
Address / (in BLOCK letter)
Tel No.: / Fax. No.
E-mail:

I/We recommend the applicant joining the “2015-16 Hong Kong Outstanding Youth Volunteers Scheme”.

Signature of Referee: / Organization Chop:
Date:

Remarks:

  1. Please put a tick  in the box.
  1. Please add separate sheets if required.
  1. Please send the completed application form with a duplicate to:

Secretariat of The Steering Committee on Promotion of Volunteer Service

Central Office for Volunteer Service

Social Welfare Department

Room 311-313, 3/ F Tai Hang Tung Community Centre, 17 Tong Yam Street, Shek Kip Mei, Kowloon

The envelope should be marked with the Title

“2015-16 Hong Kong Outstanding Youth Volunteer Scheme”

  1. The personal data provided by means of this form will be used for processing applicants’ entry for this Scheme only. Applicants have the right of access and correction with respect to personal data as provided in the Personal Data (Privacy) Ordinance. Applicants’ rights of access include the rights to obtain copies of the personal data provided by this form.
  1. The personal data provided by applicants would be used for verification and contact between applicants and the Social Welfare Department only. The information will be destroyed after 6 months of the announcement of result.
  1. The English version is for reference only. In case of any discrepancies, please refer to the Chinese version for final interpretation.

2015-16 Hong Kong Outstanding Youth Volunteers Scheme

Parental Consent

(Applicants aged below 18 should send the application form

together with the completed consent form)

I ______(Name), being the father/mother/guardian* of ______(Name of applicant), hereby give my consent to ______(Name of applicant) for joining the above scheme.

Signature: ______

Name: ______

Contact Tel no.: ______

Date: ______

*Delete as appropriate.

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