Particulars of Outstanding Creative Child with disabilities for National Awards (Annexure-M)

1. Name of the child in English (in BLOCK Capital letters) and Hindi:
2. Date of Birth(Attach Certificate):
3. Residential address along with telephone & fax number, if any.:
4. E-mail address, if any:
5. Web-site address, if any:
6. Nature and degree of disability:
7. Class in which studying:
8. Particulars of the creative work for which award is to be considered:

Signature, name & designation of the recommending authority with date

NOTE:

1. Three copies of the photographs clearly showing disability of recommended child with disabilities, to be enclosed with bio-data.
2. Application should be supported by a Medical certificate indicating the degree of total disability.