Dr.jsmlm
Dr JS Moroka Local Municipality
DR JS MOROKA MUNICIPALITY 2014 YOUTH AWARDS
ENTRY FORM
(Please select one category)
1. Economic Development(Youth Enterpruership, ICT Business, agriculture)
2. Youth in Health Care and Substance abuseprogrammes, home visits, counseling and education)
3. Youth Arts, Culture And Recreations(Traditional Dance, drama and hand craft)
4. Sports (Soccer, Netball, Volley Ball and Indigenous games)
5. Music (Artist, Dancer, Rab and choirs)
1. NOMINATOR:
Full name: ______
Surname: ______
Physical address: ______
______Postal code______
Telephone (w)______telephone (h)______
Cell phone : ______email address:______
2. NOMINEE
Name of Business/ Company/ Organisation: ______
Company registration number (if applicable): ______
Contact person: ______
Physical address: ______
______Code: ______
Postal address: ______
______Code: ______
Telephone number (W): (______)______
Cellular Number: (_____)______
Fax Number: (_____) ______
E- Mail address ______
Web address (if applicable)______
Number of years in Business: ______
How many people have you employed: ______
% Full time (Youth):______
% Part time (Youth): ______
How many clients do you serve annually (HIV/AIDS): ______
% Youth: ______
How is your Company/ Organisation adding value/ impact on customers/ clients: ______
______
What training programmes (formal / informal) do you have in place in your organization/ company, related directly in improving your services: ______
What is your rate of business per year: ______
What is rate of referred business/ clients per year:______
How do your customers/ clients rate your service? Please supply support in terms of recommendations from your clients/ customers and other organizations: ______
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Have you won other awards? If so, please list award, category and year of recognition:
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Have your company been funded previously? If yes please state the department:______
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How have you funded? R______Year ______
How did you utilize the funds: ______
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why you should be recognized as the best Company/ Organization: Motivate ( additional documents can be attached ). ______
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Nominator:
Surname ______
Fullname: ______Designation:______
signature: ______Date : ______
place : ______
Nominee
Surname: ______
Full name: ______Designation:______
signature: ______Date : ______
Place: ______
Witness 1:
Ward counselor/ Traditional leader
Surname: ______
Full name: ______Designation:______
signature: ______Date : ______
Place ______
GENERAL REQUIREMENTS
- Must reside within Dr JS Moroka Municipality
- Organization/ Company be two years or more
- It must be youth driven (14 – 35) years and the business owner should be 18 – 35 years.
- Attached profile
- Nomination letter from the nominator
- Audited statement
- Must not have won the Dr JS Moroka Municipality youth awards of excellence for the past for the past three years.
CRITERIA FOR NOMINATIONS
1. Youth in Health Care and Substance Abuse Programmes
Two years and above in programme
Working with Department of Health and Social Services
Reside within Dr JS Moroka Municipality
Registered as NPO/NGO
Having two years profile
Not less than 20 households benefited
Most of its services be youth bias age 14 – 35
2. Youth in Business (Construction, IT Business, Agriculture)
Two years and above in Business
Have Tax Clearance, profile, CK
Have employed not less than five youth employees and comply with basic condition of employment
Reside within Dr JS Moroka Municipality
The owner be aged 18 – 35
3. Youth in Art, Culture and RecreationCulture
The organization must reside within Dr JS Moroka Municipality
It must be youth driven
The organization must be registered as NPO/NGO
The organization must be two years and more
The organization must recognize type of culture that resides within the Municipality.
4. Youth in Sports
The organization must reside within Dr JS Moroka Municipality
It must be youth driven
The organization/team/ individual must be participating on organized sports
The organization/team/individual must be two years and more in the field of sports
5. Youth in Music
The organization must reside within Dr JS Moroka Municipality
It must be youth driven
The organization must be registered as NPO/NGO
The organization must be two years and more
The organization must recognize type of culture that resides within the Municipality.
Dr.jsmlm
Dr JS Moroka Local Municipality
DR JS MOROKA MUNICIPALITY 2014 YOUTH
AWARDS
ENTRY FORM
Closing date for the submission is the 06 June 2014.
No faxed, e-mailed, copies and late submissions will not be accepted.
All structures whom filled the form will be invited to the ceremony that will be before the end of June 2014.
For more information contact: Mr. Lawrence Ntshane (Assistant Youth Manager)
@ 013 973 1101