(Note: Application is to be Submitted in
duplicate. Those received in an incomplete form will not be
entertained)
1. Name and complete postal address of the
organisation
2. Whether registered under the Societies
Registration Act. 1860 (Act XXI of 1860) or any other Act (to be
specified) and date of registration. (Please enclose a copy of the
registration of the organisation in the case of first application)
3. Particulars of the present members of the
Board of Management; date on which it was constituted tenure.
4. Details of the project for which grant-in-aid
is sought :-
(i) Statement of the problem which the project
seeks to tackle
(ii) Objectives of the project
(iii) Geographical area that will be Covered.
(iv) Client group that is sought to be served
(v) Service that will be delivered; both
Institutional and non-institutional
(vi) Physical targets that the project seeks to
achieve :-
(a) existing services
(b) additional coverage of existing services and
(c) new services, (to be indicated separately in
tabular form)
(vii) Expertise/experience that the organisation
has in planning and implementing such programmes/services.
(viii) Cost estimates (separately item-wise) for
recurring and non-recurring items for each year. In the case of
staff, the salaries and allowances for each post to be given
separately.
(ix) Details of equipment, furniture etc.
required for the project with estimated cost.
(x) Details of construction of buildings or
extension to existing buildings or rent of the building in which the
service is being given (staff quarters are excluded except in the
case of warden chowkidar etc.) with estimated cost (see rule 9.1 to
9.6)
(xi) Anticipated Output of the project (to be
quantitatively specified where feasible)
(xii) Charges proposed to be collected from
beneficiaries for the services (education training, food etc.)
(xiii) Stipend,, if any, proposed to be given to
trainees
(xiv) Other charges as may be necessary for the
proper running of the programme.
5. How the institution will meet its contribution
and or the balance expenditures indicate the specific Sources with
quantum of expenditure.
6. List of papers/statements to be attached
(i) Constitution of the organisation its article
of memorandum and its aims and objective (to be submitted in the
case of first application)
(ii) Annual report for the previous year giving
inter alia the details of activities. The physical targets achieved
and the locations of the service activities should be mentioned.
(iii) A list of the staff of the organisation
alongwith a statement showing their qualifications, scale of pay,
present salary and other allowances, if any.
(iv) Information relating to the grants received
or likely to be received from Central Government, State Government,
or any other body including local bodies or voluntary organisations,
if any applications are pending with these organisation for similar
grant the details in this regard should be given.
(v) A statement of the itemised income and
expenditure of the organisation/institution for the last two years
and a copy of the balance sheet for the previous year These should
be certified by a Chartered Accountant or a Government authority
(This is applicable to organisations which have existed for more
than two years. If the organisation has a deficit, an explanatory
note may be given on how this is met)
(vi) Copy of site plans of the buildings and
other papers if
proposed (vide para 9.1 of the scheme).
(vii) Certificates as required in para's 7.3 and
9.4 of the scheme.
(viii) List of additional papers attached if,
any.
7. Additional information, if any.
Signature of the Secretary/-
President of the Organisation with stamp
Date: