同燃希望獎網上報名

協助應對新型冠狀病毒 Help fight COVID-19
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

學生姓名 (中文) Name of student (Chinese):*
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? :*
你的項目展現哪個護瞳行動的價值 (可選多項)? What values of The Fred Hollows Foundations are you showing (multiple options)?:*	行動 Action 助人自助 / 賦權 Empowerment 合作 Collaboration 真誠 Integrity
項目類型 (可選多項) Types of Actions (multiple options):*	協助應對新型冠狀病毒 Help fight COVID-19 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:*
若由家長或監護人提名，請留下地址以便寄回參加証書。Please leave your address here if students are nominated by parents or guardian to receive Certificate of Appreciation.:*
遞交提名表格，代表你的家長或監護人同意你參與同燃希望獎，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

感謝您服務社會、締造改變!