31Oct2024

Making a Difference Building Dreams Creating Impact Saving Lives

logotype

No products in the cart.

Contacts

HEAD OFFICE:                          548 Market Street,
San Francisco, CA 94104         USA

PROJECT OFFICE:                  Pearl Condo, Bldg A, 15 Fl., Kabar Aye Pagoda Rd.,      Yangon, Myanmar

hello@marykyapfoundation.org

US: +1 415 991 2030                 US: +1 415 799 8282                    MM: +95 9 977 66 7777

* indicates a required field.
The Mary K Yap Foundation’s Health Assistance Program provides essential health and wellness checks for orphaned children. By collaborating with physicians, nurses, and medical associations, we work to ensure that every child receives the care they need to maintain their health and well-being. Our collective efforts focus on fostering a compassionate healthcare network that supports these vulnerable children and helps them thrive daily.

FORM 06

Wellness Health Checks

Enhance Well-being

Step 1 of 2

1) ORPHANAGE INFORMATION:

3) ORPHANAGE LEADERSHIP (Primary people in charge)

4) CLASSIFICATION OF ORPHANS/NON ORPHANS

5) ENGLISH LANGUAGE SKILLS AMONG LEADERS:

The questions below should form the basis of a comprehensive health check services wellness plan for the orphanage, ensuring that the children’s physical, mental, and emotional needs are adequately addressed and monitored. Please include your responses on a separate piece of paper if required. A healthcare team member will develop and implement the plan to ensure its effectiveness and relevance.

The head of the orphanage/caretaker will initiate the form with the support of the Foundation's Orphanage Ambassador representatives (If Required)

1. BASIC HEALTH INFORMATION:

(a) Provide children's names, ages, and genders. (attach a list on a separate Excel Sheet if required)

Click or drag a file to this area to upload.

2. IMMUNIZATION STATUS:

3. NUTRITION AND DIETARY NEEDS:

4. PHYSICAL HEALTH:

5. Mental Health and Emotional Well-being:

6. Safety and Hygiene:

7. DEVELOPMENTAL MILESTONES:

8. EDUCATIONAL AND SOCIAL NEEDS:

9. RESOURCES AND SUPPORT:

10. OTHERS: (explain in detail for h and i)

(h) How will health information and updates be communicated to relevant stakeholders?

Add Text and Images to Your Form With Ease

To get started, replace this text with your own.

(i) How will the health and well-being of the children be monitored over time?

Click or drag a file to this area to upload.

The information provided in the above Health Checks for Wellness form is true and accurate. We accept that the information will be used only for evaluation by the relevant selection and funding committees. Once our orphanage is ready to receive assistance, a separate terms and disclosure agreement will be needed before receiving charitable support and donations. This form will need to be updated yearly.

Please kindly send back the completed form as well as attach other useful information to (hello@marykyapfoundation.org or fax at +1415-463-8478)
(eg. organizational mission and objectives, photos, press-release if available)

The information provided in the above volunteer form is true and accurate. I accept the Terms and Conditions, WAIVER AGREEMENT and PRIVACY DATA COLLECTION POLICY.

I acknowledge that the relevant committees will only use the information for evaluation. I will provide any character reference upon request and after the initial assessment.