1st DELHI DISABILITY AWARDS 2017
Application form
1. / Name: (a) in English (in BLOCK Capital letters)2. / Address: (a) Residential
3. / Telephone numbers:
(a) Mobile
(b) (Landline
4. / E-mail address
5. / Date of birth
6. / Nature of Disability (Attach Disability Certificate)
7. / Indicate percentage of disability and since when
8. / Educational qualifications
9. / Occupation
10. / Category for the Award
11. / Brief details / particulars of the achievements and work done by you for disability.
(Max 300 words)
12. / Whether any National or International award received and if so, the details thereof.
(Max 200 words)
(Signature of the recommending authority with date)
Name:
Designation:
Organisation:
Address:
Phone:
Email:
Declaration:
I ______hereby affirm that all information and documentary evidence provided along with the application is true and unforged to the best of my knowledge and that no fact(s) have been withheld or concealed intentionally or unintentionally. Any malpractice and false information and documentary evidence would lead to immediate disqualification of the application. The organizing committee reserves the rights to take a legal action if deemed necessary in case of any suspected foul play.
I also agree that this prestigious award is for the motivation of our community and I will abide be the decision of the Jury in all respect and esteem.
The decision of the committee cannot be challenged in any circumstances as the motive of the awards is inspiration, encouragement and recognition. It does not imply any sort of competition.
Date:______Name:______
Place:______Sign:______
Last date for Nominations: 31st Oct 2017: All nominations should reach on the prescribed format by the date given. Nomination only accepted by Email.
Send with the Application:
1. Passport Size Photograph
2. Disability Certificate (if required)
3. Document evidence (After shortlisted)
Categories: Social Work, Sports, Best NGO/DPO/School/Institution, Special Educator, Self Employment, Govt Employee, Life Time Achievement, Creative Person (Art/Music/Dance).
For any queries and concerns, please call or write to us:
011 27915733
Guidelines
i. One individual can apply for more than one award category.
ii. If an individual belongs to an applying organization and wishes to apply as an individual then s/he would be allowed to choose another award category. The individual can choose any nomination category in this case.
iii. One DPO/NGO/School/Organization or Institute can apply for more than one nomination in different award category and choose any nomination category.
iv. Family members and blood relatives can apply as a separate applicant.
v. Joint applications are not allowed.
vi. Applications made outside of defined categories would not be processed.
vii. Incomplete applications or applications without supporting documents would not be processed
viii. In case of any queries or concerns with your application you would be contacted. If we don’t hear from you within 5 working days then the application would be processed without updated information, even if it means you won’t qualify for next level of selection.
ix. No contact made to find the status/ progress of application would be entertained at any stage
x. You would only be notified (by your preferred mode as mentioned in the form) if you are deemed winner in the applied category. You would need to notify us of your acceptance of the award within 5 working days otherwise it would be considered as your denial to accept the award. And it would be offer to the next application on the merit list.
xi. We will not provide any kind of transport like taxi/bus Fare.
Thanks & Regards,Kapil Kumar Aggarwal
Organizing President:
Delhi Disability Awards 2017
Gen Secretary: Viklang Sahara Samiti Delhi
National Award receiver by Govt of India
Mob: 9811015733 / Pradeep Raj
Organizing Secretary:
Delhi Disability Awards 2017
Gen. Secretary: Association for Disabled People
National Award receiver by the President of India
Mob: 9350164514
1st Delhi Disability Awards 2017 / 3