Example Form

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學生姓名 (中文):*
Name of student (English):*
學校名稱:*
Name of School:*
年級和班別 Class:*
學號 Student Number :*
活動舉辦方 Who organised the activity? :*
項目類型 (可選多項) Types of Actions (multiple options):	賣旗 / 售賣慈善獎券 / 慈善義賣 / 籌款活動 Selling flags / raffles / fundraising 探訪 (如: 長者、失明人士、弱勢社群等) Visits (e.g. elderly people / visually impaired / disadvantaged groups) 清潔社區 / 環保回收 Community cleaning / environmental protection or recycling 照顧校內有需要同學 Caring for peers in need at schools 其他 Others
請簡單表達你如何積極回饋社區或幫助身邊的人 (500字內)。你也可以額外以PDF格式上載補充文件(如: 相片、獎狀、活動紀錄等相關資料)。Tell us in less than 500 words how you are making a positive impact to your community. You can upload supporting documents below. :*
上載補充文件(一) Upload 1:
上載補充文件(二) Upload 2:
上載補充文件(三) Upload 3:
提名人姓名 Nominee:*
提名人與學生關係 Relations with student:*
提名人電話 Phone number of nominee:*
提名人電郵 Email of nominee:*
遞交提名表格，代表你的家長或監護人同意你參與2020同燃希望獎，並授權護瞳行動展出或與傳媒分享有關活動或及其故事，和用作護瞳行動的通訊與教育之用。 The Foundation will be sharing stories of the students’ outstanding contributions to the community with the media. By submitting this application you confirm that the student's parents or guardian have been advised and consent to the student being named and photographed by media.:*	同意 Agree