Ministry of Development of North Eastern Region
Proforma for application of Grant-in-Aid under the Plan Scheme “Capacity Building & Technical Assistance”
a) |
Name of the Organisation |
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b) |
Address, Street, District State Pin Code, Phone & Fax No. (with STD code) E-Mail |
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c) |
Name & Designation of Chief functionary |
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d) |
Name of other key functionaries & their contact No. & Address |
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e) |
Registration details Act under which registration date of registration |
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f) |
FCRA No. (if available) |
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g) |
Activities in Brief |
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h) |
Thrust Area |
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i) |
Experience in the area in which funding is sought |
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j) |
Source of Funds (last three years) |
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National/International agency(ies) |
Name of the Project |
Amount Received |
Year |
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k) |
Banking Details (Account No. name and Address of the Bank) |
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l) |
Has the work of your organization been evaluated by any independent agency, if yes, please attach the evaluation report |
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1 |
Title of the Project |
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2 |
Aims & Objectives |
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3 |
Duration & Total Cost of the Project |
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4 |
The Project description needs to include the following details |
a. Project goal |
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b. Project area |
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c. Target Group |
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e. Details of any ‘need assessment’ done in the area before deciding on the project |
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5 |
Beneficiary(ies) Type & No. |
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6 |
Strategy/Action Plan |
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7 |
Detailed Cost estimate: Programme-wise/ Year-wise (Recurring and Non-recurring) |
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9 |
Monitoring & Evaluation indicators |
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10 |
Project Sustainability (How will the activities be sustained after project support is completed) |
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ATTACHMENTS TO BE FURNISHED* HED |
1 |
Registration Certificate |
Yes/No |
2 |
By-laws & Memorandum of Association |
Yes/No |
3 |
Annual Report – (Latest one year) |
Yes/No |
4 |
Audit Statements – (for last three years) |
Yes/No |
5 |
Latest list of Execute Committee Members |
Yes/No |
6 |
List of Employees |
Yes/No |