Simon K Y Lee Elderly Fund Invitation for Proposal

Simon K Y Lee Elderly Fund -- Invitation for Proposal

Application Form

Note:

Applications must be submitted by 5pm on 30 June 2017. Late application will not be considered

The project can be organized in more than one district and through more than one centre/service unit. Each district can have more than one centre/service unit operating the project

Please attach (i)documentary proof on the exemption from tax under Section 88 of the Inland Revenue Ordinance (Cap.112); (ii) audited accounts of the previous year; and (iii) organization chart and list of the board of directors

Deletion of any item or amendment of the prescribed format is not acceptable

After this Application Form is reviewed, selected NGO shall be invited to submit a formal and detailed project proposal

(This form can be filled out in either Chinese or English)

Name of Project: ______

Which service area will the project target?

 Digital Inclusion Elder Employment

End-of-life Care  Singleton Elders

Particulars of the applicant NGO

Name of applicant NGO: ______
Source of operating expenses:
______
Core welfare services provided:
______

Contact person of this application

Name: ______Position: ______
Address: ______
Telephone No.: ______/ Email Address: ______

Summary of project

Planned length of project: ______months / years (circle the appropriate one)

District(s) in which the project will be organized:

District / Name and address of the centre/service unit to operate the project: / Type of unit (e.g. DECC, NECs etc.)

Type of project: New project Extension of an existing project

 Others, please specify ______

Targeted service beneficiaries of the project:

Total amount requested (HKD): ______

Briefly describe what need(s) will be met by the proposed project (max. 200 words):

Describe the following components of the project: (max. 300 words)

i)Objective:
ii)Programme content and approach:
iii)Expected output, e.g. no. of beneficiaries:
iv)Need of manpower, e.g. professional staff and/or volunteers:

Describe the sustainability planning of the project, and evaluation methods (if any) (max 200 words):

Declaration of Applicant NGO

I certify that all the information given in this application is true and accurate. I understand that any inaccurate information will make the applicationinvalid.

I consent that the information provided in this application form will be used by the Simon K Y Lee Elderly Fund for processing the application and for related purposes.

Signature: ______/ Name: ______
Title: ______/ Tel. no.: ______
Email address : ______/ Date: ______
Organization Chop: ______