Part A - Application Cum Monitoring Form
APPLICATION CUM MONITORING FORM FOR GRANT-IN-AID TO VOLUNTARY ORGANISATIONS WORKING IN THE FIELD OF INTEGRATED PROGRAMME FOR OLDER PERSONS
(for Ist instalment and new cases)
PART - A
| 1. Financial year for which grant-in-aid is applied: | ________________ |
| 2. Name of the Organisation: | ________________ |
| 3. (a) Nature of the Project*: | ________________ |
| (b) Date of commencement of the Project: | _____ / _____ / _____ |
| (c) Year of Commencement of Grant-in-aid from G.O.I for the Project: | ________________ |
| (d) Whether the Project is recognised by the state government: | Yes / No |
| 4. Date of Registration of the organization: | _____ / _____ / _____ |
| 5. Address of Registered Office | ________________ (STD Code) Tel. No: (STD Code) Fax No: Email: |
| 6. (a) Complete Address of location / location where programme / project / scheme is being implemented: | ________________ (STD Code) Tel. No: (STD Code) Fax No: Email: |
| (b) Nearest Railway Station/Bus stand: | ________________ |
| 7. Whether building is: | OWNED / RENTED / ON LEASE / DONATED (Please indicate √ against appropriate box) |
* Please indicate : 1. Old Age Home, 2. Day care centre, 3. Mobile medical unit, 4. Non-institutional services.
