School-based After-school Learning and Support Programmes 2015/16 s.y.
Community-based Project – Application for Project Adjustment
(For Addition of Collaborating School only)
Project Reference No.:
EDB—Extended Support Programmes Section
Address: 1141, 11/F, Wu Chung House,
213 Queen’s Road East, Wanchai, HK
Fax No.: 3107 1306
Name of Organisation:
Project Title:
Name of New Collaborating School
Note
:
Activities to be added Note
For EDB’s Use Only
1.
2.
3.
4.
5.
Please submit this form with the Project Adjustment Form (Appendix 1) and the Declaration of New Collaborating
School (Appendix 2). Approval from EDB should be obtained before any adjustment is implemented. If the
adjustment involves transferring the surplus of a school to the new collaborating school under the same project,
written consent to the transfer from the school concerned must be obtained. In principle, the processing time is 10
working days upon receipt of all the documents required for project adjustment.
Note:
Name of project coordinator:
(Mr./Ms./Miss*)
#
Signature of project coordinator:
Name of contact person:
(Mr./Ms./Miss*)
Contact tel. no. :
Fax no. :
Date:
# Signature must be the same as the application form
*Please delete whichever is not applicable
C ho p o f
NGO /
N G O ’s
S u b s i di a r y
O r g a ni s at i o n
Appendix 1
Project Adjustment Form
(For Addition of Collaborating School only)
Project Reference No.:______________
1. Name of activity to be added：
Name of New Collaborating School:
2. Types of activity︰( “” one box only)
Tutorial service
Learning skills training
Self-confidence
development
Social & communication
skills training
Language training
Voluntary service
Leadership training
Adventure
activities
Art & cultural
activities
Sports activities
Visits/outdoor
activities
3. Briefly describe the activity’s objective, content and methods of evaluating effectiveness:
4. Estimated no. of eligible students served (headcount):
students (including _____ non-Chinese speaking
(NCS) students, _____ special educational need (SEN) students and _____ newly arrived children (NAC))
5. Date: from
/
/
to
6. No. of group(s): ________
(b) Half-day activity : ___ time(s) (c) Whole-day activity : ___ time(s)
Session: _____ hour(s)
(not less than 4 hours)
(not less than 7 hours)
Venue: _______
Venue: __________
Venue: __________
___
9. Breakdown of the budget for the proposed activity:
Expenditure items
(a)
/
7. Tutor: Teacher : Student ratio (per group): _____︰_____
8. Each group (a) Lesson: ____ period(s)
includes:
/
Tutor fee ( _______________ person(s))
($)
Social worker fee ( ________ person(s))
($)
Others (_______________ person(s)) ;
($)
Budget of Activity
to be Added*
Remarks
Please specify: ______________)
(b)
Material expenses
($)
(c)
Camp /admission fee
($)
(d)
Student meal (only for whole-day
($)
outdoor activities)
(e)
Activity transportation fee
($)
(f)
Volunteers allowance ( ______ person(s))
($)
(g)
Others (please specify:
)
($)
Total expenditure
($)
Recommended by / Date
Approved by / Date
*Please delete whichever is not applicable
For EDB’s Use
Only
(R)
(A)
Appendix 2
Project Reference No. :____________________
Declaration of New Collaborating School
(I) To be completed by the school:
We intend to refer about
eligible students (count by heads)(Note) to participate in this project
(including _____ non-Chinese speaking (NCS) students, _____ special educational need (SEN) students and
_____ newly arrived children (NAC)) and provide a list of eligible students to the NGO concerned.
(Note: ‘Eligible students’ refers to P1 to S6 students in receipt of the Comprehensive Social Security Assistance (CSSA) and full
grant under the Student Financial Assistance Scheme (SFAS) and the disadvantaged students identified by the schools under their
discretionary quota.)
Name of School:
(English)
(Chinese)
Address of School:
(English)
(Chinese)
School Code:
School Type:
School Level:
Government
Aided
Secondary
Session:
AM
PM
WD
Caput
DSS
Private
Special
Primary
Name of Teacher in-charge:
(Position:
)
School Tel. No.:
Name of School Supervisor/Principal*:
School
Signature of School Supervisor/Principal*:
Date:
Chop
/
/
(II) To be completed by the applicant NGO/NGO’s Subsidiary Organisation:
(i)
I confirm that the proposed project does not duplicate with my other current project(s) funded by other
organizations.
(ii) I consent that information provided in this application form will be used by the Education Bureau to
process the application and conduct research, evaluative studies and training/sharing session.
Name of NGO/NGO’s Subsidiary Organisation *:
Name of Responsible Person of
NGO/NGO’s Subsidiary Organisation * :
Signature of Responsible Person of
NGO/NGO’s Subsidiary Organisation * :
*Please delete whichever is not applicable
Chop of NGO /
NGO’s
Subsidiary
Organisation