Name of Voluntary Welfare Organisation:
Beneficiaries should be agreeable to the following :
willing for photos to be taken and featured
real name can be quoted
contact over the phone or face to-face interview
Name of client (For Chinese client, please also provide name in Chinese Character):
Date of Birth:
Which year did client approach your agency?
(For Schools) Is client attending the am/pm session?
Describe the hardship faced by client when he/she first sought help from your agency.
A short description of client’s disability, if any, and the year that disability happened.
Provide client’s family tree (spouse, parents, siblings), and what they do as a living.
Who is/are providing financial support to client and family?
How does your agency help/alleviate the hardship faced by the client and his family?
How has client’s current situation improved with the agency efforts and intervention?
What is the continuing effort required to assist the client?
How is client contributing to society and/or helping the less fortunate?
What is client’s next milestone after graduating from your programme? What does client aspires to do in future? What is his dream?
Provide a quote from the client on a) his/her experience with the agency and b) his/her aspirations/dreams.
(To be completed by the teacher/social worker/counsellor/therapist of beneficiary)
What has been one of the most memorable progress you have had with the client in the recent past?
What is your personal wish for the client to help him raise above his/her circumstance in the coming years? What will it take for this wish to come true?
Details last checked on (date) & by whom:
Contact person (if different from client):
E.g.: Ms Y/ Project Coordinator
ABC Centre, address