1 / UNIQUE ID (For Polestar office use only)
2 / STATE (from which applied)
3 / DISTRICT
(from which applied)
4 / DATE OF YOUR ONLINE SUBMISSION
A / RESPONDENT PROFILE
1 / Name of Organization
2 / Type of organization – NGO or Corporate
3 / Name and designation of Primary Contact Person
4 / Does your organization have a Registration Certificate?*
5 / Contact details – Email, Mobile and website link
6 / Organization PAN CARD No.
7 / Category Applied for: (Pl tick) / • Education
• Health
• Livelihood
• Empowerment
8 / Name the key activities you perform within the category
9 / Name the State/UT, District/s where you operate
10 / When did you start operations?
11 / How long have you been operating continuously?
12 / Any awards/recognitions/honour conferred?*
B / ABOUT YOUR ORGANIZATION
Vision, Mission and Goals
1 / What is the Vision, Mission and Goals of your Organization? / Not more than 150 words
2 / What made you to choose the key activities that you perform? / Not more than 150 words
3 / Why did you choose the locations where you currently operate? / Not more than 150 words
Senior Management Leadership (Pl highlight your answer choice in red)
1 / How many years of experience does the head of this organisation have? / ▪ >10 years
▪ 6-10 years
▪ 3-5 years
2 / How many Governing Body meetings have you conducted in the last 3 years? / ▪ More than 6 meetings
▪ 1-6 meetings
▪ No meeting
3 / How many Board Meetings did you conduct in the last one year? / ▪ 3 and more meetings
▪ 1-2 meetings
▪ No meeting
Governance (Pl highlight your answer choice in red)
1 / Does your organization comply with all Statutory Regulations? (80G, 12A, ITR if any )* / ▪ Yes
▪ No
2 / Have you filed IT Returns for the years you have been in operation? Please provide supporting documents for the past 2 years.* / ▪ Yes
▪ No
Accounting, audit and reporting (Pl highlight your answer choice in red)
1 / Do you update your accounts on a regular (monthly) basis? If yes, how do you maintain your Book of Accounts? / • Yes
• No
• Computerised
• Manual
2 / Do you have a copy of the organization's budget (2016-17)?* / ▪ Yes
▪ No
3 / What is your annual budget allocated for your key activities in INR?*
4 / What is your gross expenditure for the last 3 years on key activities?*
C / PROGRAMME MANAGEMENT AND DELIVERY
Programme Management (Pl highlight your answer choice in red)
1 / Do you have Programme Planning documents for the last 6 months? For example, do you have Project Implementation Plans (PIP), Logframe Analysis ( LFA) documents?* / ▪ Available for all 6 months
▪ Available for < 6 months
▪ Not available
2 / What is the type of Monitoring & Evaluation (M&E) systems followed in your organization?* / ▪ Computerized MIS
▪ Manually recorded M&E forms for all separate projects
▪ No M&E system in place
3 / How many full-time staff does your organization have?
4 / How many part-time staff does your organization depute?
5 / How many target respondents are addressed by your interventions?
6 / What is the communication and reporting pattern – internal to your organization as well as to your external stakeholders? How do you record lessons learnt and feedback into your ongoing project? / Not more than 150 words
7 / What was the quantitative impact of your activity over a specified period of time? For e.g, how did your activity increase family income, literacy levels, health improvement levels? * / Not more than 150 words
8 / What was the qualitative impact of your activity over a specified period of time? For e.g, how did your activity increase attendance rates at school, improve quality of life, decrease in alcoholism/substance abuse? * / Not more than 150 words
9 / How has the local community been involved? Did it involve a diverse cross section of the community? * / Not more than 150 words
10 / Has your project/ programme demonstrated that it is commercially viable and sustainable in the long term? / ▪ Yes
▪ No
11 / Is the project/ programme model being implemented by you replicable/ can be scaled up in similar conditions/ ecosystems anywhere? Please explain how / ▪ Yes
▪ No
12 / Is there an element of innovation in your project planning, implementation, delivery or outcome? If yes, please describe the same ( in not more than 150 words) / ▪ Yes
▪ No
13 / What are the barriers/ constraints faced by the project/ programme? / Not more than 150 words
14 / What are your plans for the future? / Not more than 150 words
* Please provide supporting documents.
About the Awards:
This year the POLESTAR FOUNDATION is introducing a new category of awards for Social Impact to recognise excellence in social development initiatives. Four awards will be given, one each in the following categories: Education, Livelihood, Health and Empowerment.
The spirit of the award
Please Note:
· Submissions for Best Social Impact awards are invited for 4 different categories. Education, Livelihood, Health and Empowerment
· Please provide Supporting documents - Copy of 12A / 80G certificate (For NGO only), Copy of certificate from auditor for your expense on CSR (For Corporates only), Copy of income-expenditure account and balance sheet for xxx (For NGO only), Other supporting documents (For NGO/Corporates). All the supporting documents will have to be shared via email or WeTransfer.
· The applicants MUST state the reasons why he/she believes the social work deserves an award
· All submissions should be sent via E-MAIL ONLY to
· The description submitted MUST be sent in a MS Word and PDF format. Videos should be in MP4 format and can be shared via WeTransfer or Google Drive
· Please sent SEPARATE submission forms for every category
· Submissions are invited starting 1st July 2017
· All submissions should reach The PoleStar Foundation latest by 31st July 2017
· Please note – there is NO ENTRY FEE for submissions
For further details:
Write to us @ ;
Reach out to our PoleStar guides:
Person / Contact numberLeo James / +91 8754469056
Balakrishna Shankar / +91 9789999841
Visit us @ www.polestar-foundation.org
FAQs
1. How do I fill the entry form?
Applications can be submitted only through the online application form. Start from Part 1 and fill up each part, following the examples and instructions. It may be advisable to download the PDF version, take a print out, fill it up in consultation with your colleagues and use that to finally make the submission online. This will be especially needed if your Internet connection is unsteady.
2. Can I send multiple entries?
You can send in multiple entries only if you are applying for an award in multiple sectors or for more than one primary activity. For example: if your NGO works in health and education, you can apply for an award in both sectors – but you will have to fill up two separate entry forms.
3. Who can apply for the awards?
Two types of applications are acceptable:
1. Non-Governmental Organisations (NGOs): Trusts or societies registered under the relevant act in India and currently functioning in India. NGOs set up and primarily funded by corporate bodies are not covered in this category.
2. Corporate Bodies: Any corporate CSR program or a corporate body or an entity set up by it as a society/trust, currently functioning in India.
4. What categories of work are eligible for awards?
Current ongoing initiatives will be considered for the award. Awards will be given for the four categories mentioned below. As examples, some types of activities are listed in each category.
1. Education: Examples: education of underprivileged, or challenged children; improving access or quality of education; teachers‟ training; development of teaching aides; development and spread of curricula; vocational or technical education centers; education in special fields like sports or music, etc.
2. Health: Examples: provision of low cost healthcare; provision or facilitation of basic healthcare to underprivileged sections; encouraging hygiene and other healthy practices; creating infrastructure for these; etc.
3. Livelihoods: Examples: any self- sustaining economic activity leading to income augmentation and employment creation, especially for under privileged sections including women, dalits, tribals; skill development; training in technologies
4. Empowerment: Examples: creating awareness and empowering communities on the above areas as well as areas such as Gram Panchayat governance and administration, Community Forest Rights entitlement, Government welfare schemes such as MGNREGA, health, hygiene and sanitation, women‟s rights, RTI, legal rights, social evils like dowry; communal harmony and national integration.
In case your work spans two or more issues, choose the category that represents maximum social impact. Alternatively apply for more than one category, but remember you will have to submit separate application forms for each category.
5. Will the selection process be transparent and unbiased?
Yes the selection process is transparent and unbiased. Names and key details of the winners will be uploaded in the PoleStar Awards website.