Particulars of the Institution for National Award (Annexure-E)
| 1 | Name of the Institution in English (In BLOCK Capital letters) and Hindi | |||
| 2 | Postal and Telegraphic address of Institution with telephone and fax number. | |||
| 3 | Web-site/E-mail address, if any | |||
| 4 | Year of establishment | |||
| 5 | Whether recognized or aided by State/Central Govt./ Local bodies | |||
| 6 | Nature of work undertaken by the Institution | |||
| 7 | Total number of employees in the Institution (also indicate the number of employees with disabilities, disability-wise). | Male | Female | Total |
| 8 | Details of work done by the Institution including places and the number of disabled persons covered by the Institution. | |||
| 9 | Specify the outstanding achievements / Contribution of the Institution in the Past ten years in the area of welfare of persons with disabilities and rehabilitation / education including technical education and vocational training to persons with disabilities. | |||
| 10 | Whether Institution have received any Award in the past. If so, specify and give brief account. | |||
| 11 | No. of persons with disabilities are on Governing Body. Give their names and addresses. | |||
| 12 | The number of disabled population served and area of work including District/State. | |||
| 13 | Give details showing various activities done by the Institution with numerical output. | |||
Note: Memorandum / Articles of Association annual reports for the last two years and like documents may be sent.
Signature of the recommending authority with date
