Hong Kong Outstanding Youth Volunteers Scheme
2006-2007
Organizer: Steering Committee on Promotion of Volunteer Service
Social Welfare Department
Partner Organization:Radio Television Hong Kong Radio 2
Hong Kong Outstanding Youth Volunteers’ Association
Supporting Media : Ming Pao
Application Form
Grouping: / Group 1 (Aged 16-19) / Group 2 (Aged 20-24)1. Recommending organization:
Name of Institution/Organization/Registered Body*
2. Particulars of applicant:
Name: / Chinese / (English)
(should be the same as recorded in HKID card)
I.D. Card No.: / Sex: M/F
Date of birth / Age:
Corresponding address:
Tel. No. / E-mail:
Education level: / Name of school:
Occupation: / (if applicable) / Name of Organization:
Years of volunteer experiences / (years) / Average service hours per year / (hours)
- Participation and commitment in volunteer service (in chronological order, starting with the most recent one with max 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
*Delete as appropriate
@ 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
(applicant can encircle more than one)
4. Experiences in planning and/ or organizing volunteer service projects (Please provide detail information on the objective, service target, number of beneficiaries, service content, service period, number of volunteers involved, number of volunteers you led and number of volunteers you cooperated with.) Please provide up to three projects in chronological order, starting with the most recent one:
5. Language skills: * Cantonese Putonghua English Others (Please specify) ______
6. Other specialskills/expertise ______(Please specify)
7. Reflection gained in volunteer experience *:
(Please limit your words to 600 in English, or 800 in Chinese)
8. Awards received on volunteer services (individual/organization)
Name of Award(please indicate whether the awards is on individual or organizational basis) / Organization / Year
(Please limit your examples to 10. Copies of awards are not required to be submitted at present stage.)
I certify that the above information provided is true and correct. I shall comply with conditions stated by the organizer.
Date: ______Signature of Applicant: ______
9. Reference Section
Referee’scomment*(Please limit the comment to 300 words in English, or400 in Chinese)
Particulars of Referee:
Name: ______Chinese) / ______(English)Rank: ______/ Name of organization: ______
Tel No.: ______/ E-mail: ______
Address:
I/We recommend the applicant joining the “Hong Kong Outstanding Youth Volunteers Scheme 2006-2007”.
Organization Chop
and Signature of Referee: ______
Date: ______
Remarks
*1. Please add separate sheets if space is not enough.
2. Please send the completed application form (with an extra copy) to:
Secretariat, The Steering Committee on Promotion of Volunteer Service
Social Welfare Department
Room 2205, 22/ F Southorn Centre, 130 Hennessy Road,
Wanchai, Hong Kong
The envelope should be marked with “Hong KongOutstanding Youth Volunteers Scheme 2006-2007”.
3. The personal data you proved by means of this form will be used for processing your entry for this Scheme only. You have the right of access and correction with respect to personal data as provided in the Personal Data (Privacy) Ordinance. Your right of access includes the right to obtain a copy of your personal data provided by this form.
4. The personal data that you provided would be used for verification and contact between you and the Social Welfare Department only. The information will be destroyed after six months of the announcement of result.
Hong KongOutstanding Youth Volunteers Scheme
2006-2007
Parental Consent
(Applicants aged below 18 should send the application form
together with the completedconsent 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: ______
HKIC no.: ______
Contact Tel no.: ______
Date: ______
*Delete as appropriate.
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