GCSRA Corporate Social Responsibility Awards

Award Category: Innovative model for CSR implementation

Application Form

General information about the company
Full name of the company
Address of the registered office
Industry classification
Year of incorporation
(Please upload Incorporation certificate)
Net profit (PBT) / FY 2013-14: / FY 2014-15: / FY 2015-16:
Total CSR spent / FY 2013-14: / FY 2014-15: / FY 2015-16:
Name of the CSR head
Please select the company category / Large (Profit before tax greater than 40 crore)
Small & Medium (Profit before tax between 5 - 40 crore)
Please select the company type / Public Sector Company
Private Sector Company
Details of the participating project
Name of the project
Illustrate how this program is unique/innovative and how is the solution envisaged from the program/initiative is different from traditional solutions? (500 words)
Target population
Details on project Funder(s)
Name(s) of project implementing Agency (if any)
Geographic outreach
Complete project Period(supporting document to be attached e.g. project inception report, NGO Agreement etc.) / Total period (years):
Completed period (years):
Project in line with CSR Rules 2014 and Schedule VII of Companies Act / Yes / No

Project Evaluation Parameters

Inclusiveness

  1. Who are the exact target group or primary beneficiaries of the project?
  1. How has the innovation led to enhanced social "Inclusiveness"? Please select your responses as applicable below
  1. Extension of range of project beneficiaries
  2. Extension of geographic spread
  3. Reduced gender disparity
  4. Bridging rural-urban divide
  5. Enhanced digital inclusion
  6. Other: ______
  1. Has the innovation enhanced geographic spread of the project? Please substantiate your response (max. 100 words)
  1. Innovation led to increased geographic spread of the project
  2. Innovation eased 'access to project benefits' across various geographies
  3. No direct impact on geographic spread of the project
  4. Other: ______
  1. Has the innovation eased or enhanced social inclusivity by number of stakeholders? Please substantiate your response (max. 200 words).
  1. More number of stakeholders/ vulnerable population covered
  2. Created new 'accessibility to benefit' mechanism
  3. No direct impact on the number of stakeholders/ beneficiaries

Relevance

  1. How has the project innovation addressed the need of the community? (max. 100 words)
  1. What are the expected outputs (refer to the overall impact of the program for the intended beneficiaries?)
  1. How 'relevant' is the innovation in the given project context? Please select your response.
  1. Provides improved processes to deliver the project
  2. Extension of corporate resources (or core competency) for specific benefits to target groups
  3. Enhances accessibility to benefits
  4. Improves affordability of benefits
  5. Beneficiaries learning new technology based skill
  6. Others ______
  1. Has the innovation led to better alignment of business's core competency with CSR (max. 500 words)?
  1. How was the project executed?

a)Self-executed by project team

b)Self-executed by project team which includes experienced ground level and technical staff

c)With support from technical institution - academic university / subject matter expert

d)With support from experienced 3rd party (project implementing agencies) for ground level execution

  1. Is an external evaluation done for the program or initiative? If yes, please provide a copy of the evaluators report.

a)Self-assessment of Impact by internal project team

b)Third party project impact assessment

c)Impact assessment in progress / not done so far

  1. Has the project received any recognition /awards/citations etc.? If yes, please indicate the nature of the award and the recognizing body.

Effectiveness

  1. Mention key performance indicators (maximum five) used in assessing the program’s progress? These may be outcome / impact indicators, depending on their importance for defining the project success.
  1. What mechanisms are used for monitoring and evaluating the above-mentioned project? (max. 200 words)
  1. Total expenditure incurred on the project and the sources of funding (separately for each funding sources):

Period / Company
Contribution / Contribution from Other Sources - I / Contribution from Other Sources – II / Contribution from Other Sources – III
Since Inception of project (indicate the year/s)
  1. What was the impact of innovation from ‘project effectiveness’ perspective? Please substantiate your response (max. 200 words).

a)Innovative delivery mechanism was introduced for solving community need which resulted in lower operational cost and greater impact

b)New technology was introduced which resulted in improved productivity, lower operational cost, improved quality of output and greater impact

c)Other: ______

  1. Has the innovation enhanced verifiability, monitoring and measurement of CSR initiative (max. 200 words)?
  1. Please elaborate on the efficiency in terms of cost and resources invested and social returns/benefits generated (value-for-money proposition)? (max. 200 words)
  1. Are there any plans to scale-up and replicate the program in other sites/locations? Identify the success factors, enablers, constraint if we scale up and replicate the program. Please indicate geographic location where you have replicated the project.

Convergence

  1. Please explain about partnerships that have helped in developing the initiative and their contribution to the overall project?Has the innovation led to Partnership/Collaboration with the GoI/ State Govt., Ministries, Flagship schemes, State Dept. and their schemes? (max. 200 words)
  1. Is Innovation a criteria for company's approach to funding?
  1. If applicable, please explain about venture partnership/social enterprise formed for sustainability of the project? (max. 100 words)
  1. What have been the main challenges in implementing the project? Also share the key learnings. (max. 200 words)

Sustainability

  1. Has the innovation led to easy exit strategy for post-project maintenance?Can the project continue after the Company withdraws? If yes, what mechanism has been put in place to ensure this? (max. 200 words)
  1. How has the innovation increased environmental sustainability?

a)Efficiencies in waste management (generation and disposal)

b)Reduced water consumption

c)Reduction in the impact on natural resources (soil & water, including floral and faunal biodiversity)

d)Sensitization and awareness generation of beneficiaries on positive environmental impact

Declaration:

I/We __[company name]__ certify that all information provided in this form is accurate and true to the best of my/our knowledge. I/We am/are willing to provide any supporting documentation/evidence that may be required to verify the information provided herein and I/We __[company name]______agree to abide by the decision of GCSRA in all matters relating to the Award.

I/We __[company name]__ declare –

  • That applicant has not been debarred, blacklisted by any Government/ Private Organization in India,and is not involved in any political &religious activities and having no criminal record.
  • That there are no pending litigations against the Applicants.

We also understand that the applicant can be barred from participation under various circumstances that include -

  • If the head/ owner/ proprietor of the company, its employee, partner or representative or an individual is convicted by a court of law following prosecution for offences involving moral turpitude in relation to the business dealings.
  • The head/ owner/ proprietor or employee or representative of the company has been guilty of malpractice such as bribery, corruption, fraud, substitution of applications, interpolation, misrepresentation, evasion or habitual default in payment of any tax levied by law; etc.
  • If the company employs a government servant, who has been dismissed or removed on account of corruption or employs a non-official convicted for an offence involving corruption or abetment of such an offence, in a position where he is able to corrupt any dealing of the organizations.

Signature

Name & Designation: ______

Date: ______

Place: ______

Guidelines for Participation:

  • Companies registered in India, both PSU and Private Sector, are eligible to apply in any of the three award categories. Branch/liaison offices of foreign companies and government departments are not eligible to apply.
  • Nominated project should be in line with CSR Rules of Companies Act (and aligned with Schedule VII of Companies Act)
  • Nominated project must be in implementation phase in the State of Gujarat, for a period of minimum two years to showcase outcomes/impact.
  • The project information provided by companies should be limited to last five years i.e. financial year April 2011 to March 2016.
  • The form must be completed in all respects (with supporting documentation attached). Incomplete or unsigned forms will not be considered.
  • One hard copy of application form, Demand Draft (Participation fees) and one CD of video or documentary film, along with the relevant supporting documents must reach at below mentioned address on or before 15th December'16 to 31st December'16 and upload a copy of all the related documents (PDF format) on website.
  • Demand Draft would be in favour of ‘Gujarat CSR Authority’ payable at Ahmedabad

Note: Any changes in the format of application form can result in disqualification of the application.

Ms. Ankita Arora

Project Officer- Gujarat CSR Authority,

3rd Floor, GSFC Building,

Opp. Drive-In Cinema,B/h Reliance Mart,

Bodakdev, Ahmedabad- 380054

Contact:

For any clarifications, you may contact:

Ms. Ankita Arora (+91-7574874044) or Mr. Padmank Jani (+91-7052002007)

Disclaimer:

All information collected will be kept confidential. However, the organizer (GCSRA) and knowledge partners (PricewaterhouseCoopers) accept no liability for any loss resulting from the disclosure of information concerning an entry, though all reasonable precautions will be taken to maintain secrecy. GCSRA will have the sole right and discretion to accept or reject entries which in their view do not meet the basic specified criteria. The decision shall be final and binding on all parties concerned.

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