APPLICATION FORM (To be submitted in two copies. In case the space shown against any column is found to be insufficient, separate sheet (s) may be attached and signed) 1(a) Name of the Institution/Organisation. (b) Mailing Address 2. Title of the project 3. Status of the institution/organisation (Professional Institutions, Employers'& Employees' organisations deemed University or any other to be stated specifically) 4. Nature of Function of the Institution/Organisation (Teaching, Examining, Research Funding other organisations) 5. Manner in which the Institution/Organisation was established (Act of Parliament, Act of State Legislature, Registered under Societies Registration Act, 1860) 6. (a) In case established under an Act of Parliament/State legislature the nature of the statute , No. of Act & year. (b) In case established under the Societies Registration Act, the place, Registration No. & Date of Registration. 7. If Semi-Govt. Organisation, the name of the Government/ Department to which it is attached. 8.(a) Whether Organisation has a source of income. (b) Whether it runs on no profit-no loss basis. 9. Brief history of the Organisation 10. Whether the Organisation has any previous experience in the field mentioned in Item I (2); if so, details thereof; -2- ( Portion II, III and IV of the Application Form should be filled in accordance with the details shown in para 8 of the Scheme) II. PROJECT OUTLINE: 1. Objective 2. Justification for taking up the study mentioned in Item I(2) 3. Relevance to the Scheme Objective 4. Approach & Methodology 5. Details of Data Collection and Analysis proposed 6. Estimated time in which project will be completed. III. STAFFING PATTERN: 1. a)name of the Project Director b)Position held by the Project Director in the Organisation mentioned in Item I(1) &Elsewhere, at present c) Major positions held by Project Director previously d) Curriculum vitae of the Project Director ( to be attached ) e) Field of Specialisation of Project Director f) Projects completed by Project Director previously and organisation for which undertaken g) List of Publications in last 3 years ( to be attached ) h) Names of other project in hand of the Project Director and names of their Commissioning Agencies. 2) Other Staff: Number of persons to be employed (Designation, Remuneration, Duration of employment to be specified); in case of senior staff, bio-data may be attached. -3- III. BUDGET ESTIMATES: 1. i) Remuneration for Project Director, Staff/Individual Researchers, etc. ii)Travelling Allowance iii)Stationery & Printing of Questionnaires, Schedules & Forms iv)Contingencies v)Computer & Tabulation vi) Overhead expenses 2. The extent of contribution by Organisation To the study in terms of staff and other Matters including financial support (mayb be Quantified in financial terms IV. ADDITIONAL INFORMATION: 1. Whether the Institution/Organisation is itself aware of any study having been done in regard to the Project shown in Item I (2) 2. Any other remarks. V. LIST OF DOCUMENTS TO BE ATTACHED WITH EACH COPY OF APPLICATION FORM 1. Memorandum of Association and Rules/ Constitution. 2. Composition of Board of Governors/Executives Or Governing Body. 3. Latest available Annual Report. (Signature of Authorised Person) Telephone No. Date: Place:
