NATIONAL SERVICE SCHEME

DIRECTORATE OF V.H.S.E.
PROFORMA FOR SPECIAL CAMPING
1. Name of school and unit No. : ………………………………………………
2. Name of Programme Officer : ………………………………………………
3. Theme of special camp : ………………………………………………
4. Schedule of camp : ………………………………………………
5. Place of Camp with full details : ………………………………………………
6. Details of volunteers selected : Boys Girls Total
(i) Student ..……… ………… …………
(ii) Non-students ..……… ………… …………
(iii) Teachers ..……… ………… …………
7. Place of work : ………………………………………………
8. Address of the nearest telegraph : ………………………………………………
Office / contact phone no. with : ………………………………………………
STD code.
9. Route from the school to the : ………………………………………………
camp site ( in detail ) ………………………………………………
10. Distance from the school : ………………………………………………
11. Whether the camping programme
is in the adopted slum / village : ………………………………………………
12. Agencies / departments contacted
and proposed to be involved : ………………………………………………
13. Details of projects to be taken up : ………………………………………………
during the camp period : ………………………………………………
(Separate sheet may be used) ………………………………………………
………………………………………………
14. Any other information : ………………………………………………
Signature of Programme Officer
Counter signature of Principal
Place : ………………………
Date : ………………………