Application for Scheme a of Special One-Off Grant s1

Section I Part A Evaluation Report for Phase 2 of Social Welfare Development Fund (SWDF)

Note: This Evaluation Report is to be used for the last financial year of Phase 2, and should be submitted to Subventions Section, Social Welfare Department, 38/F., Sunlight Tower, 248 Queen’s Road East, Wanchai, Hong Kong by the end of October 2016, or 2017 (or 2018 if applicable).

Name of NGO (Code): ( )

Section I Annual Progress Report for Financial Year 20 -

Part A – Overall Report

1. Approved Funding Allocation in Phase 2 (including IT and non-IT projects) (a) Approved fund in the first round application : $ (b) Approved fund in the second round application : $ (c) Approved fund in the final round application : $ (d) Total approved fund in Phase 2 [ (a) + (b) + (c) ] : $ (e) Funding allocation in each financial year : $ (2013-14) $ (2014-15) $ (2015-16) $ (2016-17)

2. Income and Expenditure for the Financial Year (20 - )

Particulars $ $ (a) Balance of SWDF brought forward : (a) (b) Allocation from SWDF during the financial year : (b) (c) Interest received during the financial year : (c) (d) Expenditure under SWDF during the financial year: 1. Expenditure for projects under scope A 2. Expenditure for projects under scope B(non-IT) 3. Expenditure for projects under scope B(IT) 4. Expenditure for projects under scope C 5. Expenditure for administrative support Total expenditure during the financial year: (d) (e) Balance as at 31 March 20___ : (e) (e) = (a) + (b) + (c) - (d) Remark: The financial information reported above should tally with those disclosed in the NGO’s Audited Financial Statements.

1 Section I Part A 3. Actual Expenditure for the Financial Year (20 - )

No. Name of project2 Approved Actual Utilisation (including expenditure on relief workers) budget expenditure3 rate (20___-___) (20___-___) % ($) ($) Scope A – Training and professional development programme Local T&D programmes 1 2 3 Sub-total of local T&D programmes Outside-HK T&D programmes 1 2 Sub-total of outside-HK T&D programmes (a) Total of Scope A % Scope B – Business system upgrading projects (including IT and non-IT projects) Non-IT projects 1 2 IT projects 1 2 (b) Total of Scope B % Scope C – Studies aiming at enhancing service delivery 1 2 (c) Total of Scope C % (d) Administrative Support % Grand Total [ (a) + (b) + (c) + (d) ]4 %

4. Declaration We confirm that the expenditures listed in Part A, Part B and Part C under the SWDF have been spent in accordance with the requirements stipulated in SWDF Guidance Notes for Application, SWD’s approval letter(s) and the procurement of projects and services are in line with the procedures specified in the Lotteries Fund Manual.

Signature : Name in Block Letter : Title : NGO Head Board Chairperson Date :

5. Information of Contact Person Name in Block: Title: Telephone No.: Fax No.: E-mail:

2 Please mark “#” after the programme if the programme is a joint project. 3 The amount of NGO’s contribution for projects under Scope A and Scope B should be excluded from the actual expenditure. 4 The total expenditure should tally with the amount disclosed in the NGO’s Audited Financial Statements.

2 Section I Part A

Part B-1 – Training and Professional Development Programmes for the Financial Year 20 -

(a) Number of participation of subvented staff / board members in approved T&D programmes

No. of subvented staff / board members Implementation participation6 period S/N Name of the T&D programme5 7 Junior Non- (mm/yyyy to Social Work Social Social Staff Board mm/yyyy) Work Work sub-total Member Staff Staff Staff (i) Long-term local T&D programmes (i.e. training over one year) 1 2 3 Sub-total of (i) (ii) Short-term local T&D programmes (i.e. training for or less than one year) 1 2 3 4 5 Sub-total of (ii) (iii) Outside HK T&D programmes 1 2 3 Sub-total of (iii) Grand Total [ (i) + (ii) + (iii) ]

(b) Headcount of subvented staff and board members having benefited from T&D programmes

No. of Headcount 6 Junior Non- Item Social Social Social Staff Board Work Work Work sub-total Member Staff Staff Staff Headcount of subvented staff and board members having benefited from the T&D Programmes in 1(a) above

5 Please mark “#” before the programme name if the programme is a joint project, and mark “@” if any relief worker is employed to relieve subvented staff to attend the programme. 6 “Participation” refers to the number of T&D programmes attended by a staff member, i.e. a staff member attending two T&D programmes is counted as two staff participations. 7 Other than Junior Social Work Staff who joined the welfare sector after Year 2000.

3 Section I Part A (c) Number of participation of non-subvented staff8 in approved T&D programmes

Implementation No. of non-subvented staff participation No Name of the T&D programme period (mm/yyyy to Social Non-Social mm/yyyy) Worker Worker Sub-total 1 2 3 Total:

(d) Approved relief worker employed in T&D programmes

T&D Expenditure programme(s) (daily wage Relief Worker requiring the × duration) relief worker10 ($) Daily Post Rank No. Wage9 Duration10 ($)

Total headcount of Total expenditure: relief workers:

(e) Detailed report for outside-HK T&D programmes (fill in for each completed outside-HK programme)

S/N in Name of the outside-HK No. of participant Average Average Total (a)(iii) T&D programme (by headcount) expenditure expenditure expenditure of Part (Please specify the per staff per board [ (a)×(c) B-1 destination city and country) member member + (b)×(d) ] ($) (after ($) deducting 50% contribution) ($) (c) (d) No. of No. of Total staff board member

8 The number of non-subvented staff attending each T&D programme such as a sharing session, talk or seminar at no additional cost should not exceed 20% of the total number of enrolled participants in the T&D programme. 108 Please specify the wage at daily rate only. 99 Please specify the total days for employing relief workers. 1010 Please specify the corresponding S/N of the relevant T&D programme(s) in Part B-1(a), e.g. if the relief worker is to relieve a subvented staff attending the outside-HK programme in (iii)1, then enter (iii)1.

4 Section I Part A (a) (b)

Total: Total:

Part B-2 – Business System Upgrading Projects (Non-IT) for the Financial Year 20 - (Please use separate sheet for each project)

(a) Name of the project : (b) Objectives : (c) Implementation period : from (mm/yyyy) to (mm/yyyy) (d) Approved budget :

(e) Breakdown of actual expenditure for the financial year (excluding NGO contribution11):

No. Expenditure items Expenditure ($) (i) Total personal emolument for temporary staff employed, if any (ii) Payment to contractor, if any (iii) (iv) (v) Total (should tally with the amount reported in Item 3 of Part A)

(f) Contribution from NGO:

No. Item Amount ($) (i) Total actual cost of the project (including NGO’s contribution) (ii) Total approved allocation (iii) Total contribution from the NGO [ ≥ (i) × 15% ] Source(s) of contribution (please specify):

(g) Breakdown of expenditure incurred in employing temporary staff12, if any:

No. Item (i) No. of staff employed: (ii) Monthly emolument per staff: $ $

11 NGO is required to make a 15% contribution of programme expenses for system upgrading projects. The NGO contribution cannot be charged to LSG or LSG Reserve. 12 Staff cost, if any, should be on project basis and non-recurrent in nature.

5 Section I Part A (iii) Duration of employment (dd/mm/yyyy to dd/mm/yyyy): (iv) Post title & duties:

(h) Name of contractor, if any:

(i) Implementation progress (please “” as appropriate): □ On schedule Tentative completion date (please specify): □ Behind schedule Please specify difficulties encountered and the revised work schedule:

(j) Briefly list the tasks / activities carried out during the year:

(k) Specify the areas upgraded / upgrading in the project:

(l) Output/outcome evaluation:

(i) Specify the output / outcome indicators.

(ii) Evaluate the output / outcome after carrying out the system upgrading project (to be completed after completion of the whole project)

(m Remark, if any )

Part B-3 – Studies Aiming at Enhancing Service Delivery for the Financial Year 20 - (Please use separate sheet for each project)

(a) Name of the study : (b) Objectives : (c) Implementation period : from (mm/yyyy) to (mm/yyyy) (d) Approved budget :

(e) Breakdown of actual expenditure for the financial year:

6 Section I Part A No. Expenditure items Expenditure ($) (i) Total personal emolument for temporary staff employed, if any (ii) Payment to consultancies, if any (iii) (iv) (v) Total (should tally with the amount reported in Item 3 of Part A)

(f) Breakdown of expenditure incurred in employing temporary staff13, if any:

No. Item (i) No. of staff employed (ii) Monthly emolument per staff $ $ (iii) Duration of employment (dd/mm/yyyy to dd/mm/yyyy) (iv) Post title & duties

(g) Name of contractor, if any:

(h) Composition and operation of project steering committee formed to oversee the study14 which was carried out by temporary staff:

(i) Implementation progress (please “” as appropriate): □ On schedule Tentative completion date (please specify): □ Behind schedule Please specify difficulties encountered and the revised work schedule:

(j) Brief description of the study:

Item Description Objectives of the study Subvented service(s) covered in the study No. of the subvented service unit(s) involved

13 Staff cost, if any, should be on project basis and non-recurrent in nature. 14 NGOs may employ staff to carry out studies with the condition that proper mechanism e.g. project committees, be in place to monitor and oversee the operation of the studies.

7 Section I Part A Name of the subvented service unit(s) involved Sample studied Sample subjects (e.g. service users, carers) Sample size

How far the study can enhance the existing service delivery (to be completed after completion of whole study)

Part C – Joint Projects for the Financial Year 20 - (To be completed by the lead NGO; please use separate sheet for each project)

1. Name of the joint project : 2. Name of the lead NGO :

3. Contact person of the approved joint project Name : Correspondence address : Telephone no. : Fax no. : Email :

4. Names of other participating NGOs: (a) (b) (c) (d) (e)

5. Approved budget of the joint project $ 6. Total expenditure of the joint project $ 7. Total expenditure charged to SWDF after deducting the NGO’s contribution, if applicable $

8. Expenditure breakdown of each participating NGOs including Lead NGO:

No. Name of participating NGO Actual Individual Total amount Source of expenditure of NGOs’ charged to SWDF contribution 15 individual contribution , for individual (should not be NGOs if applicable NGOs LSG or LSG ($) ($) ($) Reserve)

15 Only for outside-HK T&D programmes joined by board members under Scope A and for business system upgrading projects under Scope B.

8 Section I Part A

(a) (b) [ (a) – (b) ] 1. (the Lead NGO) 2. 3. 4. 5.

9 Section II Part A-B Section II Overall Usage of Approved Funds in Phase 2

Part A – Total Income and Expenditure in Phase 2 (both IT and Non-IT)

$ % Income (a) Total funding allocation received in Phase 216 (b) Total interest received in Phase 216 (c) Total income in Phase 2 [ (a) + (b) ] 16 Expenditure (i) Scope A – Training and professional development programmes % (ii) Scope B – Business system upgrading projects (Non-IT) % (iii) Scope B – Business system upgrading projects (IT) % (iv) Scope C – Studies aiming at enhancing service delivery % (v) Administrative support % (d) Total expenditure in Phase 2 [ (i) + (ii) + (iii) + (iv) + (v) ] 16 100% (e) Surplus (or Deficit) in Phase 2 [ (c) – (d) ] (f) Remaining funds in Phase 2 to be clawed back17 by SWD [ i.e., (e) if it is a surplus ]

Part B –List of All the Approved Projects in Phase 2

No. Name of project18 Approved Actual Utilisation (including expenditure on relief workers) budget expenditure19 rate % ($) ($) (i.e. actual expenditure ÷ approved budget × 100%) Scope A – Training and professional development programme Local T&D programmes 1 % 2 % 3 % 4 % 5 % Sub-total of local T&D programmes % No. Name of project20 Approved Actual Utilisation (including expenditure on relief workers) budget expenditure21 rate

16 The actual amount should tally with the sum of the relevant amounts disclosed in the NGO’s Audited Financial Statements for the relevant financial years of Phase 2. 17 According to paragraph 31 of Guidance Notes for Application-Phase 2 of Social Welfare Development Fund, any surplus of approved funds by the end of Phase 2 will be clawed back. 18 Please mark “#” after the programme if the programme is a joint project. 19 The amount of NGO’s contribution for projects under Scope A and Scope B should be excluded from the actual expenditure. 20 Please mark “#” after the programme if the programme is a joint project.

- 10 - Section II Part A-B % ($) ($) (i.e. actual expenditure ÷ approved budget × 100%) Outside-HK T&D programmes 1 % 2 % 3 Sub-total of outside-HK T&D programmes % (a) Total of Scope A % Scope B – Business system upgrading projects (including IT and non-IT projects) Non-IT projects 1 % 2 % 3 IT projects 1 % 2 % 3 (b) Total of Scope B % Scope C – Studies aiming at enhancing service delivery 1 % 2 % 3 (c) Total of Scope C % (d) Administrative Support % Grand Total [ (a) + (b) + (c) + (d) ]22 %

Part C –Usage of Administrative Support (please “” as applicable)

Expenses of the administrative support in Phase 2 (which should not exceed 5% of the NGO’s funding cap in Phase 2 or $500,000, whichever is the less)

In case the total expenses of administrative support exceed the 5% or $500,000 cap, please provide justifications below for SWD’s assessment:

21 The amount of NGO’s contribution for projects under Scope A and Scope B should be excluded from the actual expenditure. 22 The actual amount should tally with the sum of the relevant amounts disclosed in the NGO’s Audited Financial Statements for the relevant financial years of Phase 2.

- 11 - Section II Part D Part D –Additional Information in respect of T&D Programmes in Phase 2 (please “” as applicable)

1. Headcounts attending approved T&D programmes No. of Headcount Junior Non- Social Item Social Social Staff sub- Board Work Work Work total Member Staff Staff Staff No. of subvented staff and board members having benefited from T&D Programmes in Phase 2

2. Expenses of the approved T&D programmes for board members in Phase 2 (which should not exceed 15% of the NGO’s total budget of T&D programmes) Item (a) Expenses of T&D programmes for board members in Phase 2 $ (b) NGO’s total expenses of T&D programmes in Phase 2 $ (c) % of expenses of T&D programmes for board members in Phase 2 % [ (a) ÷ (b) × 100% ] In case the total expenses of T&D programmes for board members exceed the 15% cap, please provide justifications below for SWD’s assessment:

3. Expenses of the approved T&D programmes outside-HK in Phase 2 (which should not exceed 30% of the NGO’s total budget of T&D programmes) Item (a) Expenses of T&D programmes outside-HK in Phase 2 $ (b) NGO’s total expenses of T&D programmes in Phase 2 $ (c) % of expenses of T&D programmes outside-HK in Phase 2 % [ (a) ÷ (b) × 100% ] In case the total expenses of T&D programmes outside HK exceed the 30% cap, please provide justifications below for SWD’s assessment:

4. Expenses arising from the purchase of materials/tools/reference books for direct training purpose in Phase 2 (which should be capped at $20,000) Purchasing Items (a) $ (b) $ Total: $ In case the total expenses exceed the $20,000 cap, please provide justifications below for SWD’s assessment:

- 12 - Section II Part D

5. The number of non-subvented staff attending each T&D programme does not exceed 20% of the total number of enrolled participants in each T&D programme and there is no additional cost incurred. In case the number of non-subvented staff attending each T&D programme exceeds 20% of the total number of enrolled participants in each T&D programme, please provide justifications below for SWD’s assessment:

Part E –How the staff / NGO benefited from the approved projects in Phase 2:

Scope A (Training and professional development programmes):

Scope B (Business system upgrading Non-IT and IT Projects):

Scope C (Studies Aiming at Enhancing Service Delivery):

Overall Comment (if any):

- 13 -