APPLICATION FORM FOR SANCTION OF GRANT UNDER THE SCHEME FOR DESTITUTE CHILDREN 1 Name of the Institution selected for expanding service : 2 Address : 3 Copy of the constitution and the list of the members of the Executive Committee : 4 Date of Registration under Societies Registration Act : 5 Present capacity of Institutional service for children : 6 Number of children at present served : 7 Age of range of children : 8 Boys and Girls or mixed : 9 Type of children serviced: : a) Destitute Children : b) Delinquent Children Committed : 10 Types of accommodation : i Type of Building : ii Average floor area allowed to each child for sleeping : iii Whether cots are used for whether children slee on floor : iv) Nature of Services offered : a Boarding : b Education : c Vocational Training : d Recreation : e Case work service : f Medical Aid : g Other service from of Rehabilitation Services : 11 Approach to organisation of services : a Through dormitories : b Cottage System : 12 Nature of personnel employed and their training : a House Parents : b Dormitory incharge : c Cook and helper : d General Education Teachers : e Vocational Instructors : f Case worker (State Qualification, experience) : g Recreation worker : h Superintendent (state qualification and experience) : i Any other : 13 Existing level of expenditure per child per month : a Food : b Clothing : c Accommodation : d Health checkup and medicine : e Bedding : f Education : g Vocational Training : h Recreation : i Any other : 14 Expenditure on salaries of personnel : 15 Nature of supervision (by paid or voluntary) : 16 Capacity of expansion of services : a Accommodation available for taking more children : b Number of additional children that could be provided with services. : 17 Assistance received by the organisation during last year 1983-84 from : a Central Government : b State Government (Edu. Dept.) : c State Council Welfare Advisory Board : d Central Social Welfare Board : e Private donations : f Any other : 18 Copy of the audited statement of accounts for last three years also state and average number of children present per month during the year : 19 Assistance sought for taking care of additional children : a Staff (State, designation, qualification, pay scale and total remuneration) : b Furniture and equipment : c Accommodation : i Whether land is available : ii Type of building : iii Cottage or dormitory : iv Total floor area : v Average floor area to be allotted to each child for sleeping : vi Cost : vii Amount to be contributed : 20 Any other information :
