请表伊利请表伊利沙伯女皇弱智人士基金拨款申

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1、伊利沙伯女皇弱智人士基金撥款申請表ApplicationforaGrantfromQueenElizabethFoundationfortheMentallyHandicapped(QEFMH)擬議計劃Proposedproject計劃名稱Projectname(最多廿五字)(in25wordsmaximum)(中文)(inChinese)(必需填寫required)(英文)(inEnglish)(必需填寫required)申請的計劃Schemeapplied(pleaseticktheappropriateONE)(必需填寫r

2、equired)每張申請表只可提交一個計劃PleaseuseseparateformforEACHscheme¨智障人士高齡化服務支援計劃(申請資助額為港幣$20,000至$100,000)請答第(i)項Pleasegotoitem(i)SchemetoSupportAgedPersonswithIntellectualDisability(AmountofgrantappliedshouldbefromHK$20,000toHK$100,000)¨獨立生活設備支援計劃(申請資助額為港幣$20,000至$50,000)請跳答第(

3、ii)項Pleasegotoitem(ii)SchemetoSupportPersonswithIntellectualDisabilityforIndependentLivingFacilities(AmountofgrantappliedshouldbefromHK$20,000toHK$50,000)¨一般資助計劃(申請資助額為港幣$30,000以上)請跳答第(iii)項Pleasegotoitem(iii)GeneralSupportScheme(AmountofgrantappliedshouldbeaboveHK$3

4、0,000)計劃性質Natureofproposedproject(i)智障人士高齡化服務支援計劃的性質(請選出最適切的一項)NatureofSchemetoSupportAgedPersonswithIntellectualDisability(pleasetickthemostappropriateone):o購置器材、設施purchaseofequipment/facilities(o康復rehabilitationo訓練trainingo資訊科技、電腦IT,computero康樂recreation)o小型工程minor

5、capitalworkso服務及訓練serviceandtrainingo公眾教育publiceducationo康樂leisureandrecreationQEFMH(2010)–Page9of9–(ii)獨立生活設備支援計劃的性質(請選出最適切的一項)NatureofSchemetoSupportPersonswithIntellectualDisabilityforIndependentLivingFacilities(pleasetickthemostappropriateone):o購置器材、設施purchaseofe

6、quipment/facilities(o康復rehabilitationo訓練trainingo資訊科技、電腦IT,computero康樂recreation)(iii)一般資助計劃的性質(請選出最適切的一項)natureofGeneralSupportScheme(pleasetickthemostappropriateone):o購置器材、設施purchaseofequipment/facilities(o康復rehabilitationo訓練trainingo資訊科技、電腦IT,computero康樂recreation

7、)o小型工程minorcapitalworkso服務及訓練serviceandtrainingo公眾教育publiceducationo康樂leisureandrecreation計劃詳情Descriptionofproposedproject(下述每項最多五十字)(in50wordsmaximumforeachofthefollowingitems)(iv)目的objective(必需填寫required)(v)舉辦理由(必須闡明如何透過建議的計劃達至上述計劃的目的)justifications(mustelaborateho

8、wtheobjectiveoftheprojectoutlinedabovecanbeachievedthroughtheproposedproject)(必需填寫required)(vi)地點location(vii)計劃推行時間#:約月/年*(*請刪去不適用