Application to the Sustainable Development Fund (By an Individual)

Sustainable Development Fund
Application Form (by an Individual)

Part 1

/ Information about the Applicant
Name of Applicant:
Hong Kong Identity Card Number:
Occupation:
Telephone Number:
Fax Number:
Address:
E-mail Address:
For application involving collaboration with other person(s) (who are not project staff, paid or voluntary)
Name of Collaborating Person(s):
Role and Responsibility of Collaborating Person(s):
Telephone Number(s):
Fax Number(s):
E-mail Address(es):
Name of Contact Person(s):
Note: Collaborating persons should have no pecuniary interest in the project and if there are exceptional circumstances making this impracticable, the applicant shall set out clearly details of the interest involved and explain why such interest could not be avoided, and attach such details to this application.
Experience of Implementing Projects
Please describe briefly any relevant projects implemented in the past 2 years.
If you have submitted any other applications in the current round of SDF application, please give the title of the other projects and the relative priority of this application.

Part 2

/ Project Proposal
Project Details
Name of the Project (in both English and Chinese):
Proposed Project Commencement and Completion Dates:
Proposed Number ofParticipants in the Project(please separately state the number of direct and indirect participants[1]):
Proposed Number of Project Staff (Paid and Voluntary) (If paid staff will be employed, please complete the “Information of Paid Staff” on page8 of this form):
Project Nature and Target Groups:
Details of Specific Activities or Programmes:
Deliverables of the Project:
Objectives of the Project
Objective(s) of the Project:
Please clarify how the project can achieve these objectives and how you would measure the effectiveness of the project (for example, you may wish to outline targets that your proposed project is intended to achieve).
Please explain how these objectives relate to the purpose of the SDF and how the project would satisfy the assessment criteria set out for SDF applications, and clarify which of the three aspects of sustainable development the project would integrate and how.
Please clarify whether, and if so, how the project will be sustained after support from SDF ends.

Part 3

/ Budget
The Amount of Grant Sought from the SDF:
Please provide a budget summary and projected cash flow for the project in accordance with the format on page 7 of this form.
Please indicate whether the project is currently receiving a grant from any Government fund or private sponsorship (in kind or in cash).
If yes, please provide details (e.g.,name of fund, amount of grant and items supported by the fund, etc.). / Yes No
Please indicate whether the project is the subject of a separate application for Government fund or any other form of private funding.
If yes, please provide details (e.g., name of fund, amount sought and progress of application, etc.). / Yes No

Part 4

/ Other Information
Please provide any other information relevant to the project proposal that you consider should be taken into account in processing the application.
Declaration by the Applicant
I certify that the information given in this application is true, accurateand complete. I understand that if I willfully give any false information or withhold any material information, the application will become void and any grant approved will be withheld and any payment made with interest must be refunded by me to the Government. In the event that my application is successful, and without prejudice to other rights and powers of the Government, I consent to the disclosure from time to time by the Government of details of the project.
Signature of Applicant:
Name of Applicant:
Hong Kong Identity Card Number:
Date:
Declaration by the Warrantor
I hereby certify that the information given in this application is true, accurateand complete.
Signature of Warrantor:
Name of Warrantor:
Occupation:
Hong Kong Identity Card Number:
Contract Telephone Number:
Date:
Disclosure of Information
In the event that your application is not successful, and without prejudiceto other rights and powers of the Government, please indicate whether youconsent to the disclosure from time to time by the Government of your name,title of the project, and the amount of the grant applied for.
Yes No
Checklist for Applicant
To help us process your application as quickly as possible, please kindly check that you have done the following:
1.Completed all sections of the application form.
2.Signed the declaration, and arranged a warrantor to sign the declaration in the respective forms set out above.
3.Attached relevant supplementary information on the Project (if any).
You are reminded that failure to supply the required documents or information may result in the application being rejected.
Submission of Application
By e-mail: Submission of application forms by e-mail is preferred. Completed application forms can be e-mailed to . Please download application forms from
By post : Please forward thecompleted application formwith supporting documents directly to:
The SDF Secretariat
Sustainable Development Division
Environment Bureau
46/F, RevenueTower
5 Gloucester Road
Wanchai
Hong Kong
Applications received by mail will be dated by the postmark. Late applications will not be accepted.

Budget Summary and Projected Cash Flow (Please attach detailed budget where necessary)

Projected Project Expenditure / Projected Project Income (please specify each source of income) / Amount requested from SDF
(c)(a)-(b)
Expenses Category / Item Description / Quantity / Unit Cost / Total
(a) / Fees & Charges / Internal Source / Other Sponsorship / Total Income
(b)
Programme Cost
Sub-total
Staff CostNote 1
Sub-total
Administration Overheads Note 2
Audit Cost
Total
Note:1.If staff cost amounts to 50% or more of the total budget for the project, please provide justifications. If paid staff will be employed, please also complete the table on page 8 of this form.
2.Administrative overheads such as stationery, postage, photocopying charges, insurance, utilities, etc. are subject to a cap of 10% of the total expenditure of the project. Breakdown of such expenses should be provided. / Amount requested from the Fund : / 2018 / 2019 / 2020 / 2021
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Total

Information of Paid Staff

Position
(Number of staff to be employed) / Experience and Qualification Required / Job Duties / Part-time/
Full-time Staff* / Equivalent Working Days/Hours
(for Part-time Staff only) (e.g. xx half-days/hours
per month or throughout the whole project period) / Salary
(including Mandatory Provident Fund)

*Please delete as appropriate.

Annex

Application for Sustainable Development Fund
Personal Information Collection Statement

Purpose of Collection

The personal data provided in this application will be used by the Government of the Hong Kong Special Administrative Region (“Government”) or the Sustainable Development Fund (“SDF”) Secretariat for the followingpurposes:

(a)processing and assessing the application;

(b)the daily operation of SDF;

(c)monitoring and evaluating the funded project;

(d)taking any remedial or follow-up action on the funded project;

(e)meeting the requirements to make disclosure under the requirements of any law;

(f)conducting research;

(g)recording and preparing statistics; and

(h)any purposes relating to any of the above.

2.Your provision of all the personal data requested in the application is voluntary. Your application may not be considered if you fail to provide all information as requested.

Classes of Transferees

3.The personal data provided in an application for SDF may be transferred or disclosed by the Government to any person for the purposes of verifying the particulars provided and other purposes relating to the application.

Access to Personal Data

4.The individuals whose personal data is provided in thisapplication have the right of access and correction with respect to personal data as provided for in sections 18 and 22 as well as Principle 6 of Schedule 1 of the Personal Data (Privacy) Ordinance (Cap.486) (“PDPO”). If you wish to exercise such a right, please contact Sustainable Development Division of the Environment Bureau. A fee may be charged in accordance with the PDPO for providing access to or correcting any data and for providing the information.

Enquiries

5.For correction of or access to personal data after submission of the application, please contact Executive Officer (Sustainable Development) 3 of the Environment Bureau:

Address:46/F, Revenue Tower, 5 Gloucester Road,

Wan Chai, Hong Kong

Telephone: 3150 8166
Fax: 3150 8168
Email:

[1]Direct participants refer to personswho are directly involved in the project activities. Indirect participants refer to those who donot participate in the project activities but may have access to the deliverables of the projects (e.g. visitors to exhibitions, targeted readers of publications and browsers of project website, etc.).