如有查詢，請致電 3405 5322或電郵 [email protected] 與國際培幼會發展教育主任鄭秋盈聯絡。
Name: (in Chinese)中文姓名
Name: (in English)英文姓名
Nickname:別名:
Date of Birth (Must be 15-21 years old)出生日期:(必須為15-21歲)
Mobile no./WhatsApp手提電話/WhatsApp
Email電郵
Gender性別MaleFemale
Tel. no.(Home)住宅電話
Facebook
Address地址
School就讀學校
Class and Department (if applicable) attended in academic year 18-19:18-19 學年就讀班級及學系(如適用)
Language(s) that you have good command of:精通語言
Participation in Plan International Hong Kong activities, please select the year曾參與的培幼會活動，請選擇年份
Youth Conference青年會議Participant Year:參與年份:—Please choose an option—N/A2016201720182019
Because I am a Girl - Exposure Trip「愛.女孩」─ 體驗之旅Participant Year:參與年份:—Please choose an option—N/A201720182019
Be a Change-makerParticipant Year:參與年份:—Please choose an option—N/A2016201720182019
Others其他Please Specify:請註明:
How did you hear about this programme?您如何得知此活動Website/網頁Social Media/社交媒體Email/電郵Friends/朋友School/學校
Name姓名
Relationship與參與者的關係
Contact no. (Daytime)日間聯絡電話
Mobile no.手提電話
HKID no.身份證號碼
Type of Travel Document旅遊證件類別
Travel Document/Passport no.旅遊證件/護照號碼
Nationality國籍
Place of Birth出生地
Date of Issue簽發日期
Date of Expiry有效至
Any major or chronic medical conditions?, if yes please give details:以往曾否患有嚴重 / 長期性的疾病?
Any surgery or hospitalizations you have had in the past?, if yes please give details:以往曾否因病入院接受治療、檢查或大小手術?
Any regular prescriptions?, if yes please give details:是否需要長期服藥?
Any allergies to food, medications, conditions, etc?, if yes please give details:是否有食物、藥物或其他敏感?
Any special dietary needs?, if yes please give details:是否需要特別膳食安排?
1. Have you ever joined any overseas exposure/service trips in the past?, if yes, please give the specify year, destination, and organizer1. 你過往有參加過海外體驗/服務團嗎?
2. Why would you like to join ‘Be a Change-maker 2020’, and what are your expectations for the programme? (Not more than 200 words in English or Chinese)2. 請簡述你參加「Be a Change-maker 2020」的原因及對此次活動的期望。
3. Plan an activity for you and other participants to share your learnings upon returning from the exposure trip with your family, friends, and schoolmates, and to enhance their understanding towards girl’s rights and child protection issues. (Not more than 200 words in English or Chinese. Hint: You could consider describing the aims, format, content, and materials needed for the activity)3. 試策劃一個活動,讓你及其他參加者於回程後與身邊的家人朋友同學分享旅程中的學習成果,加深他們對女童權益及 保護兒童議題的了解。(300 字以內,中英不限。提示..可簡述初步構思如活動目的、活動形式及內容、活動對象及 人數等。)
Photocopy of HKID香港身體證副本 Photocopy of travel document (personal information page)旅遊證件(個人資料頁)副本 School calendar of academic year 2019-20 19-20年度校曆副本 Parent / Guardian Consent (for applicants under the age of 18)家長同意書(十八歲以下之申請人必須填寫)Download下載 Recommendation forms completed by school teacher/ affiliated organization (if applicable)就讀學校老師/所屬團體推薦表格 (如有)Download下載 Financial aid application (if applicable)財政資助申請表 (如有)Download下載 If you do not wish to receive upcoming promotional materials of Plan International Hong Kong, please put a tick ‘√’ in this box.勾選，如不欲收取由培幼會發出之推廣資料
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