Nomination Form Select Application TypeGoverrnmentPSUCorporateCorp. FoundationNGOMSMEIndividualStart-upCSRProfessionalothersSelect Award CategoryCSR Leadership AwardBest Innovative CSR Project AwardBest CSR Leader AwardBest CSR Impact AwardBest NGO of the Year Award (Non Govt Organization)NGO Leadership Award (Non-Govt Organization)CSR Professional Award (Non-Govt Organization)Basic InformationName of the OrganizationCompany Website URLDate of IncorporationFull AddressState/ProvinceZIP / Postal CodeNature of the business & its products/servicesContact DetailsName of the Organization's HeadHead's DesignationHead's EmailHead's PhoneName of the CSR HeadCSR Head's DesignationCSR Head's EmailCSR Head's PhoneName of the Officer handling this awardOfficer's DesignationOfficer's EmailOfficer's PhoneSelect Project CategoryEradicating extreme hunger and povertyPromotion of educationPromoting gender equality and empowering womenReducing child mortalityImproving maternal healthCombating human immunodeficiency virus, acquired, immune deficiency syndrome, malaria and other diseasesEnsuring environmental sustainabilityEmployment enhancing vocational skills, social business projectshealthcarerural developmentsustainable agriculture Contribution to the Prime Minister’s National Relief Fund or any other fund set up by the Central Government or the State Governments for socio-economic developmentRelief and funds for the welfare of the Scheduled Castes, the Scheduled Tribes, other backward classes, minorities and women and such other matters as may be prescribed.About the Project/project for which award is being claimed Name of the ProjectPeriod of Operation of ProjectLocation/s of ProjectNo. of Beneficiaries for the YearDetails of Project (maximum 200 words)Choose FileNo file chosenDelete uploaded fileProject CostOne Time Project CostOperational Cost of ProjectNature of Outcome/impact on the beneficiaries - explain in 200 wordsShort term impactChoose FileNo file chosenDelete uploaded fileLong term impactChoose FileNo file chosenDelete uploaded fileSponsor of the projectName of the SponsorAddress of the SponsorContact NumberEmail IdWebsite URLAny other award/s received for this projectChoose FileNo file chosenDelete uploaded fileComments of the beneficiaries of the projectName of the executing agency of the project. if done by an NGO, please mention the details along with their scope of work and responsibility in about 100 wordsSubmit report of impact assessment, if executed by any third party for this project(in max. 200 words)Any additional informationPlease note nominations submitted with incomplete form, in respect of information sought and/or non-payment of nomination fees will be rejected..UndertakingI/We hereby declare that all the information given above is true and correct to the best of my/our knowledge. I/we understand that this application shall be processed by a team of the experts and placed before the jury. Additional information as required by the jury will be furnished by me/us in a particular time frame. If required, I/we shall attend a meeting with the Jury about my/our nomination.SUBMIT
