IICA-NGOBOX CSR Case Study Recognition 2015

IICA-NGOBOX CSR Case Study Recognition 2015

IICA-NGOBOX CSR Good Practice (Case Study)

Recognition 2015

Please select the Category of Case Study Entry (Only one category/Application)

0 Livelihood

0 Education

0 Gender equality & Senior Citizens

0 Environment, Sustainability & animal welfare

0 National heritage

0 Armed force veterans, war widows and their dependents

0 Rural sports, Nationally recognized sports, Paralympics sports and Olympic sports

0 Technology incubators

0 Rural development

0 Slum development

(Please read the Case study-guidelines carefully before submitting this form)

Please send filled in form and application fee to the address given below and email a copy to

and

Mrs Gayatri Subramaniam

Convener & Chief Programme Executive
National Foundation for Corporate Social Responsibility(NFCSR)
Indian Institute of Corporate Affairs (IICA)
2nd Floor, Paryavaran Bhawan, CGO Complex, Lodhi Road,
New Delhi - 110 003

Date: Location:

Part A: Organizational Profile

A1 / Name of the organization applying for the CSR Good Practice (Case Study)Recognition (Full Name) (Please do not use acronym)
A2 / Office Address / Address:
Contact No.
A3 / Contact Person for this application (This will be the nodal contact point for this application) / Name:
Designation:
Mobile:
Email:
Alternate Contact no.
A4 / Organization website
A5 / Type of organization / 1.Registered society/NGO/Trust
2.For profit company
3.Not-for profit section 25 company
4. Community based organization/SHG
5.Academic/Research institution
6. Others…………………………………………….
A6 / Name of the CEO/President/Director
A7 / By submitting this application form, the organization agrees to provide all the project related information during the assessment process and will abide by the rules set by the organizers. The applicant also acknowledges that all the information provided in this application form is correct.

Part B: Basic Information about the Case Study

B1 / Title of the Case Study
B2 / CSR Project of Company/Companies
B3 / CSR Project Implemented by (Main Implementing Organization)
B4 / CSR Project Partner (Implementation and Monitoring)
B5 / CSR Project Budget (INR) / Total Budget for the project
Budget in FY 2014-15
B6 / Project Began in Month/Year
B7 / Project Duration
B8 / Project Location/Coverage Area
(district/state)

Part C: Case Study Description (max. 8 Pages, minimum font size 11)

(Please read case study design points in the guideline document. For photographs and other additional requirements use annexure with appropriate references in the case study description)

Signature

Name

Designation