EGSAIE Proforma

(2 Copies of the project proposal are required to be submitted to the

Department of Elementary Education & Literacy along with this application form)

Education Guarantee Scheme and Alternative & Innovative Education Programme of the Sarva Shiksha Abhiyan - Experimental & Innovative component funded directly by Government of India

APPLICATION FORM

(To be filled by the applicant)

1. Name, address, telephone number, fax : ___________________________________________

number and e-mail address of the Agency ___________________________________________

___________________________________________

2. Its objects and activities (give brief history) : ___________________________________________

________________________________________________________________________________________

3. Whether registered under Indian Societies Registration Act, 1860 (Act XXI of 1860), public trust or non-profit making company? Give number and attach copy of the relevant document. A copy of the Memorandum of Association or equivalent document be attached.

4. Whether the agency has an All India Jurisdiction, if so, attach copy of the relevant document.

5. Whether the organization has any experience in elementary or non-formal education for children? If so, a brief mention may be made indicating the type, size and location of the programmes organized. Please specify if the organisation has run projects earlier from the Non-formal Education Programme / EGS & AIE Scheme of Sarva Shiksha Abhiyan under the Ministry of Human Resource & Development or similar programmes with assistance from the State Government. If so, the current status and clear evidence be attached that previous accounts (audited statement) have been settled with Government of India / State Government.

________________________________________________________________________________________

6. The title of the experimental and innovative project for which the grant is applied for and the details of the project including highlights of the innovative / experimental features. CLEARLY INDICATE THE NATURE OF INNOVATION / EXPERIMENT IN PROPOSAL.

7. (i) In case any teaching / learning process is part of the proposal CLEARLY indicate whether the materials prescribed by the State Board or CBSE will be adopted. In case any different materials are proposed to be used, then a copy of same may be ENCLOSED with the proposal.

(ii) If any publication is to be made through project funds, then its draft version be enclosed with the proposal.

8. Details of Block / Municipal Area / District etc. where the Voluntary Agency will operate the Scheme should be specified in a separate Annexure: (INDICATING THE NUMBER OF CENTRES, NUMBER OF CHILDREN, COST PER CENTRE AND COST PER CHILD ALSO).

9. The duration of the project : ____________________________

10. Whether any part of the expenditure on the projects is being or is likely to be provided by some other official, non-official or foreign source? If so, indicate the extent and the name of agency. Please also specify the own contribution of the Voluntary Agency to the project.

________________________________________________________________________________________

11. Total estimated expenditure on the project : Rs. ___________________

( item-wise and year-wise details to be attached).

(i) Non-recurring : Rs.____________________

(ii) Recurring : Rs. ___________________

12. Total Amount of grant requested : Rs. ___________________

(i) Non-recurring : Rs. ___________________

(ii) Recurring : Rs. ___________________

13. Whether the organisation is seeking or obtained or applied for grants for same purpose or activity from any other Department of State or Central Government.

14. Whether the institution has adequate personnel to look after the project? If so, indicate details.

________________________________________________________________________________________

15. List of papers / statements to be attached:

(a) Constitution / Trust Deed of the Agency.

(b) Constitution of the Board of Management / Governing Body with particulars of each member giving their telephone number and e-mail address, if any.

(d) Audited accounts for the last three years along with a copy of the certified balance sheet for the preceding year.

(e) In case organisation has run NFE / EGS & AIE / similar State Government Programmes, then audited statement showing settling of accounts for that period.

(f) Copy of Books, if any, published by the Agency.

(g) Copy of Registration Certificate.

16. Additional information, if any.

Signature of the authorized person with

Name, designation and stamp

Place: _______________

Date: ________________