Project Proposal under NaiRoshni, the Scheme of Leadership Development of Minority Women for !"#$"% &' Sl. No.

1 2 3 4 Details of (r)ani*ation+ Particulars Name of Organization Address of Organization Whether Society/Trust/Company/Others ate of !egistration "ith !egistration Num#er $%&ease enc&ose a &egi#&e copy of 'a&id !egistration Certificate( )f it is in other &anguage* it shou&d #e trans&ated in +indi or ,ng&ish and attested #y istrict -inority We&fare Officer . Name of %resident/ Chairman Name of Secretary Te&ephone/-o#i&e2 ,mai&2 Information

/ 0 1 3

,To be communicated in case of change. &&&' D e t a i l s of Project Location+ Sl' No' 1 2 Particulars Proposed Location of Project hether location !inorit" #oncentration District &nformation District: Block: Village: the proposed 'es&(o falls in

) * + -

$!#D%& !inorit" Total Population of proposed District Percentage of !inorit" Population in proposed ,ate Literac" among minorit" females in the proposed district (ames of !inorit" #ommunities a.ailable in proposed District $!uslims/ #hristians/ 0ikhs/ Buddhists/ Parsis/
ebsite.

,List of !#Ds&!#Bs&To1ns is a.ailable on !inistr"2s

&-' Sl' No' 1 2

Details a.out proposed Project+ &nformation

Particulars Theme $s% of proposed Leadership de.elopment Training3 Brief justification for selection of theme for training Duration and Dates of Proposed Training Total number of participating minorit" 1omen Do all of them belong to BPL categor" 5f not/ ho1 man" of them belong to BPL hether proposed training is ,esidential or (on7 residential #ommunit"71ise number of participating minorit" 1omen $list of .eneficiaries to .e )iven as per /nne0ure$&% Duration: 4rom: To:

) * + 6 8

'es&(o

!uslims: #hristians: 0ikhs: Buddhist: Parsis: 9ains: (on7minorit"&others: Total: Details of ,esource !ale: Persons $1o .e )iven as 4emale: per /nne0ure$&&% Total:

3The training modules are a.ailable on !inistr"2s 1ebsite in ;nglish and <indi. The training programme should be 1ithin the frame1ork of Training !odules designed b" the !inistr".

-' 2rief /pproach the 1rainin)3s

of

or)ani*ation

for

conductin)

-&'

/rran)ements made for hand$holdin) and nurturin) of trained 4omen $please gi.e clear details ho1 the organi=ation proposes the handholding process/ resource persons for hand holding nominated and the mechanism in.ol.ed%.

-&&'

Proposed 2ud)et 5stimate 6to .e enclosed prescri.ed rates )iven in the scheme )uidelines7+ ;nclosed& (ot7enclosed $/nne0ure $ &&&%

at

-&&&' /ccounts of the (r)ani*ation+ Sl' No' 1 Particulars !ention "ear up to 1hich accounts ha.e been audited $b" the month of 9une e.er" "ear/ it should be a.ailable for pre.ious financial "ear% Please enclose: Latest >udited >ccounts:2?1?711/ 2?11712/ 2?1271) &nformation

;nclosed&(ot ;nclosed $/nne0ure$ &-% ;nclosed& (ot ;nclosed

@tili=ation #ertificate in A4, ;nclosed&(ot ;nclosed 1:$>% authenticated b" #hartered accountant: $Not applica.le in case of ne4 or)ani*ations 3projects

&8'

Details of /ssets of the (r)ani*ation3s

8'

Whether or)ani*ation has ever .een .lac9listed, if so, please indicate+ $i% (ame of Blacklisting >uthorit": $ii% Date of Blacklisting: $iii% ,eason from blacklisting: $i.% Date of deletion of name from Blacklist:

8&'

&nfrastructure availa.le 4ith the or)ani*ation to conduct proposed trainin) 6s7

Sl' No' 1

Particulars Location and >ddress of Building 1here the proposed training $s% are to be conducted 4acilities in the building hether building has electric and 1ater facilities hether building is rented or o1ned 5f rented/ indicate lease period $if an"%. ;nclose cop" of lease deed. 5f training is ,esidential/ please indicate

&nformation

2 ) * +

(o. of Training ,ooms: (o. of Toilets: 'es&(o

(o. of ,ooms in hostel: (o. of toilets: 4acilities of electric&1ater $hot 1ater in case training is in 1inter%: 'es&(o 4acilit" of Bitchen&mess: 'es&(o 0leeping arrangements: 'es&(o 0ecurit" arrangements: 'es&(o3

6 $a%

5f training is (on7 residential/ please indicate distance from the area .................... Bilometre from 1here participant minorit" 1omen ha.e been proposed to be co.ered

$b% !ode of transportation a.ailable from the targeted area to place of training
3>t least t1o securit" staff should be females.

8&&' Details of 2an9 /ccount of (r)ani*ation : to .e )iven in Proforma for /uthori*ation 6availa.le at 4e.site7 duly authenticated .y Mana)er of the concerned 2an9 2ranch' 8&&&' Declaration .y President3Secretary of the (r)ani*ation 5/ ..............................................President&0ecretar" of

....................................................../ son & daughter & 1ife of of ................................................................. resident ......................................................................... $>ddress% hereb" declare that the information gi.en abo.e is true to the best of kno1ledge. The organi=ation takes the responsibilit" of securit" of 1omen during training period/ especiall" for 1omen 1ho 1ould undergo ,esidential Training. 5nclosures+ 0ignature of President or 0ecretar" $Ai.e 4ull (ame 0igning >uthorit"% Cfficial 0tamp 8&-' Lists3Documents to .e enclosed+ $i% >ll Documents as reDuired in !andator" criteria as in Para 55 abo.e. $ii% !anaging #ommittee of Crgani=ation: ;nclosed & (ot7 enclosed $iii% $i.% $.% $.i% ;Eecuti.e #ommittee of the Crgani=ation: ;nclosed & (ot7enclosed $if an"%. 0taff of Crgani=ation: ;nclosed & (ot7enclosed. >nnual ,eport of pre.ious financial "ear. Bond on ,s.2?&7 (on79udicial 0tamp Paper $the format of language on bond is a.ailable on !inistr"2s 1ebsite%. The Bond should be signed and stamped properl". Proforma for >uthori=ation $a.ailable at 1ebsite% dul" authenticated b" !anager of the concerned Bank Branch.

$.ii%

Note+ Since issues related to 4omen are sensitive, the person authori*ed to formulate the project should .rief family mem.ers3hus.ands 6if they a)ree7 on the Pro)ramme3Scheme and its )uidelines' Prefera.ly a female 4or9er should .e sent to frame the scheme in the locality 4here the pro)ramme 4ould .e implemented' 5verythin) must .e done in a transparent manner' 1he Panchayati Raj &nstitutes 6PR&s7, ;r.an Local 2odies 6;L2s7 may also .e ta9en into confidence'

/nne0ure$& <ommunity$4ise Details of 1rainee Women 6as per details )iven in Para &- $=7 1heme of 1rainin)+'''''''''''''''' >inancial ?ear+ Duration+ >rom+ ''''''''''''''''''
Sl' No' Name of 1rainee Woman Dau)hter 3 Wife of

1o+ '''''''''''''''''''''''''''''''''''
>ull /dd$ ress /nnual >amily income Date of 2irth3 /)e 5ducati$ onal @ualific$ ation of trainee Name of <ommu$ nity /adhaar /ny 3 ;&D other Num.er Rem ar9s3 6if availa.l &D e7

Note+ "' 1his list of 4omen trainees should .e duly authenticated .y Aead of Panchayat3 Municipal 2ody3 Local /uthority 4ith official stamp' ' 1his list should .e su.mitted .y or)ani*ation .efore start of trainin), once the project is sanctioned' B' &n case of more than one theme, these details are to .e )iven separately for each trainin) as /nne0ure & 6/7, 627''' and so on'

0ignature of President or 0ecretar" $Ai.e 4ull (ame 0igning >uthorit"% Cfficial 0tamp

#ountersign of <ead of Aram Pancha"at& !unicipal Bod"&Local >uthorit" $(ame of 0igning >uthorit"F.% Cfficial 0tamp&0eal

/nne0ure$&& Details of Resource Persons 6as per details )iven in Para &- $C7 1heme of 1rainin)+'''''''''''''''' >inancial ?ear+ Duration+ >rom+ ''''''''''''''''''
Sl' No' Name of Resource Person Se0 6M3>7

1o+ '''''''''''''''''''''''''''''''''''
/)e /ddress 5ducational @ualification >ield of Speciali*ation 350perience ,Name of (r)ani*ation to 4hich Resource Person .elon)s

Note+ "' &n case of more than one theme, these details are to .e )iven separately for each trainin) as /nne0ure && 6/7, 627''' and so on'

0ignature of President or 0ecretar" $Ai.e 4ull (ame 0igning >uthorit"% Cfficial 0tamp 3,esource persons can be from Ao.ernment/ (on7Ao.ernment/ Public 0ector @nits/ @ni.ersities/ Banks etc.

/nne0ure$&&& 2ud)et 5stimates 6,efer Para : of 0cheme Auidelines7 1heme of 1rainin)+'''''''''''''''' >inancial ?ear+ Duration+ >rom+ ''''''''''''''''''
Sl' No' &tems of 50penditure

1o+ '''''''''''''''''''''''''''''''''''
No' of persons Rates 6in Rs'7 Duration3 ;nits 1otal <ost 6in Rs'7

Note+ 2ud)et estimates for Residential and Non$residential 1rainin)s to .e )iven separately'

0ignature of President or 0ecretar" $Ai.e 4ull (ame 0igning >uthorit"% Cfficial 0tamp