1. Revenue district :
       
2. Name of Voluntary Organisation/Society managing
the school(With complete address)
:
       
3. School code :
       
4. Name with address of the school/institution for
financial assistance required
:
5. Objects and activities(give brief history of the
/society managing the school:)
:
6. Specific activities of the school for which financial
assistance is sought under the scheme
:
7. Whether registered under the Centra/State Board? : Yes No
8. Organisational structure,total staff.their roles and responsibilities,
staff turnover of educational
institute/school for which assistance is being
sought and the voluntary organisation/society
:
9. Governing Board/Managing Committe-number of
members,their role,meeting held and attendance,
their involvement in decision making of
educational institution/school and the voluntary
organisation/society concerned(List of members
may be enclosed)
:
       
10. Bank name :
       
11. Branch name :
       
12. IFSC Code :
       
13. Account No: :
       
14. Name and address of auditors,legal
advisors(including details of accounts)of voluntary organisation/society
:
15. Details of infra-structural facilities availible with
educational institution/school for whom,
assistance is being sought
:
a. Whether the building is rented or own? :
b. No. of rooms availible for classes and
Administrative purposes
:
c. Sufficiency of accomodation for reading :
d. Whether seperate rooms for science laboratory,library etc,are available. :
e. No.of teachers subject-wise already
working with their name,qualification etc.
(if needed attach sheets)
:
f. Number of children enrolled in respective
classes relevent to purpose for which
assistance is being sought.(at least 3 years
data be given)
:
       
16. Action Photographs about the school :
17. Sucess stories/testimonials/award/recognitions
and how the work of school has made difference to the individual,
family and for the community
:
18. Community/client involement in the academic
affairs pof school/educational institution
:
19. future plans and sustainability :
20. Audited balance sheet,income and expenditure
statement for the last three years of voluntary
agency and educational institution and school for
which assistence is sought
:
       
21. Annual repeot if any of VA/educational institution or school :
22. Inforamtion on existing funding sources with break
up grants,loans,and corpus received by VA and
educational institution/school for which assistance is being sought
:
23. Whether the educational institution/school is
receiving financial assistance for infrastructure
development of any kinds from any other source;if
so details thereof:
: Yes No
24. Amount required for additional :
Item Number Amount required* No. of children to be benefited
classrooms
Science rooms
Computer lab rooms
Library rooms
Toilets(Girls)
Toilets(Boys)
Drinking water facilities
Hostels for girls
Hostels for boys
Educational facilities like ramps/labs for children with special needs
any other educational infrastucture requirement
Total
25. Voluntary Organisation/Society's Share equal to
25% towards item 18 and commitment of
voluntary Organisation/society to provide the same:
:
26. Source of investment of voluntary organisations/
society's share given against item 18
:
27. Central Govt share equal to 75% reqiured against item 18 :
       
School Basic Details
       
28. Community of management :
       
29. Specify Category(Aided,Unaided) :
       
30. Category of Agency(corporate,charitable Trust Etc.) :
       
31. Whether Higher secondary,Secondary or Primary :
       
32. Specify No.& date of Recongition :
33. Specify the Registration No.& Date of Minority Status Certificate Obtained From the National Minority Commision :
34. Whether the agency has three years of existence : Yes No
       
35. Whether the school has three years of existence : Yes No
       
36. Whether Performance report enclosed with application : Yes No
       
37. No.of students in the school(for 2013-14) :
       
38. Source of commitment of the agencies to provide the amount :
39. Ground for grant :
40. Details of Proposed work to be done by using financial assistance.Write each item :
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