檔案編號Reference Number
SPF

Application for Special Project Fund (SPF) under the

AIDS Trust Fund (ATF)

for HIV Prevention in MSM

Project Title
(in both Chinese and English)
Date of submission
Proposed date of implementation / From ( / )
(month / year) / To ( / )
(month / year)

Complete one set of application form for each proposal

Application must be made using this standard form. Supplementary information may be submitted but the ATF Secretariat has no obligations to consider the extra information.

Applicant must submit Section Two (A), (B), (C) of the application form, title, indicatorsand objectives of the project in both Chinese and English.

For Category A or B, please complete Sections 1, 2, 5, 6, 7, 8.

For Category C, please complete Sections 1, 2, 3, 4, 7, 8.

In case of any inconsistencies or contradictions between the English and Chinese versions of SPF application form, the English version shall prevail.

Last updated: 20December 2007

SECTION ONE –Category of proposals and grant

Please  as appropriate:

A. Please indicate the category of your proposals
Category A:Prevention projects with predefined objectives (PPP) (choose one only)
 / Project A1.Promoting the practice of safer sex among MSM seeking relationship through internet
 / Project A2.Improving condom and lubricant access at venues where MSM sexual activities occur
 / Project A3.Empowering the men who newly come out to engage in same sex relationship
 / Project A4.Reducing HIV risk in the context of recreational drug abuse
 / Project A5.Supporting infected MSM for HIV prevention
Category B – Others with preferredproject areas (can tick more than one)
 / Objective 1.Increase awareness of HIV, risk perception, and foster safer sex practice among MSM
 / Objective 2.Promote HIV testing for MSM at risk of HIV infection
 / Objective 3.Promote holistic approach to the promotion of sexual health and management of sexually transmitted infections among MSM
Category C –Public Health Research projects
 / RA1. Social, contextual, psychological or other factors affecting the practice of unsafe sex/ safer sex among MSM
 / RA2. Pattern of use of drug abuse /recreational drug use and its associated risk for HIV infection
 / RA3. Pattern of MSM activities outside Hong Kong among Hong Kong men and its risk for HIV acquisition
 / RA4. Awareness and attitudes towards HIV testing among MSM and their testing pattern
 / RA5. Segmentation of MSM populations in HK in relation to HIV risks, and HIV prevention strategy (involve qualitative study and size estimation on each sub-populations)
 / RA6. Other research areas leading to development of practical recommendations that are useful in facilitating effective HIV prevention in MSM in HK.
Specify research area for RA6: [ ]
B. Please indicate amount of grant requested from SPF
 grant requested / [ $ ]

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SECTION TWO –Applicant’s information

*Please complete in both Chinese and English. Please provide background of the organisation by attaching Certificate of Incorporation, Business Registration, Annual Report and other/or relevant document.

  1. Applicant organization and collaborating organisation

  1. Name of organisation:

  1. Executive director:

  1. Address:

  1. Mailing address: (if different from above)

  1. Telephone:

  1. Facsimile:

  1. Email :

  1. Board of Directors (if appropriate)

  1. Chairman name/title:

  1. Mailing address: (if different from above)

  1. Telephone:

  1. Facsimile:

  1. Email :

  1. List of names and titles of all other board members:

  1. Contact information for individual responsible for this proposal

  1. Name/Title:

  1. Mailing address:
(if different from above)
  1. Telephone:

  1. Facsimile:

  1. Email :

Official use:

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  1. Description of organisation

  1. Has your organisation organisedprojects for local MSM in the past?
Please  as appropriate: / No
Yes
If yes, please list out (max 5 projects )
  1. Has your organisation organised projects on HIV in the past?
Please  as appropriate: / No
Yes
If yes, please list out (max 5 projects )
  1. If your organisation had no prior related experience, please provide evidence on your organisation’s ability to implement the project proposed. (max. 100 words)

Official use: 2 1 0

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  1. Title

  1. Introduction (100 words):

  1. Aims and objectives ( both in Chinese and English) (100 words):

For official use 2 1 0

SECTION THREE –Research Proposal

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  1. Plan of investigation:
Study Design, Methods, Data Processing & Analysis, Timeline
(Formatting
Page limit: / Not more than 4numbered pages may be allowed
Font: / At least 12-point, preferable Arial.
Character Spacing:
Margin: / Normal
Left at least 2.5 cm and Right at least 1.5cm
Line Spacing: / At least Single )
For official use 2 1 0

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SECTION FOUR – Public health significance of the research

  1. Purpose and Potential for implementation of results (200 words):

For official use 2 1 0

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  1. Key References: (Appropriateness & completeness)

  1. Additional Materials (e.g. questionnaires)

Please indicate “”

 Project A [ ] OR

 Project B with  objective 1  objective 2  objective 3

SECTION FIVE – Project plan
A. Work plan
Please submit the objectives of the project in both Chinese and English.
  1. Specific Objectives
/
  1. Activities leading to meeting the objectives
/
  1. Target outputs or outcomes

List out & describe activities / Responsible persons / Timeline
B. Have similar projects or activities been implemented or evaluated in other settings, locally or elsewhere?  Yes No
If yes, please quote examples or source for reference.
If no, please briefly explain how or why the proposal will be effective in meeting its objectives?
For official use: A: 2 1 0 B:2 1 0

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C. Principles checks
Special Project Fund project principle / Did you apply the followings in your project proposal? (Please  as appropriate)
If yes, please describe how they have been applied (100 words)
Principle 1. Projects should preferably be carried out in established channels, such as internet sites, chatrooms, venues frequented by MSM, or events or activities in gay community /  No, I did not.
 Yes, I did. Description:
Principle 2. Projects should preferably be designed to involve the process of mobilizing and empowering the local MSM/gay community to enhance community response to HIV in HK /  No, I did not.
 Yes, I did. Description:
Principle 3. Projects should be designed to reach a high or reasonable coverage of MSM population in Hong Kong /  No, I did not.
 Yes, I did. Description:
Principle 4: Projects should be designed to foster a supportive environment for practice of safer sex among MSM of positive, negative or unknown HIV status /  No, I did not.
 Yes, I did. Description:
For official use 4 3 2 1 0

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SECTION SIX – Monitoring and evaluation
A. Monitoring and process evaluation
  1. Number and profile of clients reached
/ Specify indicators / How data is collected? / Targets
  1. Type and quantity of interventions delivered
/ Specify indicators / How data is collected? / Targets
  1. Tracking difficulties in carrying out activities / areas for which the process can be improved?
/ Specific questions to be addressed / How these questions are answered? / How will be the solution be used?
4. Others
B. Outcome evaluation ( if appropriate)
  1. Specify outcome objectives
/ Specify indicators / How data is collected? / Targets
  1. Difficulties or factors affecting achievement of outcome objectives
/ Specific questions to be addressed / How these questions will be answered? / How will the information be used?
  1. Others

For official use: 2 1 0

SECTION SEVEN – Resources requested

Category 1. Human resources*
a. Position and numbers / b. Full time/part time / c. Job description / d. Duration of employment / e. Rate of payment / f. Total Budget for each position
Please describe job in terms of
  1. approximate time spent per time period, e.g., 30 hours outreach each week
  2. qualification
  3. level of salary compared to market price
  4. duties and responsibilities

TOTAL BUDGET on human resources / $
Category 2. Material *
Item / Quantity / Justification / Cost per unit / Total per category
Total BUDGET for material: / $
Category 3. Equipment *
Item / Quantity / Justification / Cost per unit / Total per category
Total BUDGET for equipment: / $
Category 4. Others*
Item / Quantity / Justification / Cost per unit / Total per category
Total BUDGET for others: / $
TOTAL BUDGET on resources / $
Anticipated income / $
TOTAL AMOUNT OF FUNDING REQUESTED FROM AIDS TRUST FUND / $
For official use: 2 1 0
*Please give a detailed itemised breakdown of each category.

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SECTION EIGHT – Declaration

  1. I declare that our organisation has not received other sources of funds for the activities described in the application.
  1. I / our organisation will notify ATF Secretariat within 10 working days if our organisation subsequently receives any other sources of funds within 10 working days.
  1. I have read, fully understood and agreed with the Special Project Fund Application Guidelines.

Signature of applicant
Name of applicant
Name of Organisation
Chop of applicant organisation (if any):
Date

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