Award Application | BIPF Shambhavi Puraskar

Eligibility for Individuals / Group of Individuals:

Age of the Applicant should be less than 70 years.
Should have minimum 5 years of grassroot level work experience, or
having working on social innovation since last two years.
The recipient(s) volunteering in individual / Group Capacity working for social cause/ social innovation can be from any profession.
Should not have received any National &/or State level Premium award.

Eligibility for Organisation:

Should have minimum 5 years of grassroot level work experience, or
having working on social innovation since last two years.
Should not have received any National &/or State level Premium award.

Eligibility for Nominations:

An individual or an organization can nominate any individual / social innovator or start-up / group of individuals or an organisation working for social cause.
Age of the Individual Applicant should be less than 70 years.
An applicant / nominee should have minimum 5 years of grassroot level work experience.
An applicant / nominee should not have received any National &/or State level Premium award.

Social Innovation

Idea, Method or Intervention should be Original
Technology used should for Nobel cause or social purpose, ethical in nature
Free of legal cases
Should have innovation and creativity and sustainable in nature
Project should be in operation since last two years

APPLICANT'S BACKGROUND

Select Applicant Type *

Area of Intervention * (Please Tick Mark any one that is deemed most important)

Social Innovation

Education

Healthcare

Water and Sanitation

Livelihood

Women Empowerment

Advocacy

*Note: If you are NOMINATING an Individual / Group of Individuals / Organisation please fill up the details and then fill up your own details.

Individual Applicant Details

Applicant Name *

Age *

Date of Birth *

Gender *

Category *

Diffently Able/Dibyang *

Present Occupation (Max: 100 Characters) *

Group Of Individual Detail

Name of the Group *

Years Of Experience in Social Work *

Member 1

Applicant Name *

Age *

Date of Birth *

Gender *

Category *

Diffently Able/Dibyang *

Present Occupation (Max: 100 Characters) *

Organization Details

Organization Name *

Year Established *

Registration Number *

Type of Organization *

Mission Statement (Max: 200 Characters) *

Present Address

Address Line 1 (Max: 150 Characters) *

Address Line 2 (Max: 150 Characters)

Address Line 3 (Max: 150 Characters)

State *

District *

City/Village *

Pin Code *

Recommendations

Name *

Address *

State *

District *

City/Village *

Pin Code *

Upload Signature *

Project/Activity Brief [** Marked questions are mandatory to answer]

Focus Area *

Title of the project/ Activity *

Background of the project/Activity (max 300 words) *

What was the source of funding the project / activity ?

Period	Own	Funding Source	Amount	Percentage	Action

Geographical area covered (Not more than 300 words) *

Beneficiaries covered (by category, gender and age group)

Enter Number Of Direct Beneficiarie(s) *

Enter Number Of In-Direct Beneficiarie(s) *

Activities Undertaken (Not more than 300 words) *

Impact on the target group (Not more than 300 words) *

Does the project/ activity has an evaluation report? (If Yes, Submit the project evaluation report) *

Has the Project / Activity led to any Community participation (If Yes, Submit a brief note, Not more than 300 words) *

Innovation/innovative strategy, if applicable (Not more than 300 words)

Sustainability of the Project / Activity (Not more than 300 words)

Scale up of the Project / Activity (Not more than 300 words)

Please write how in your opinion this project/ activity merit for "Shambhavi Puraskar" (Not more than 300 words)