1. Revenue district :
2. Name of Voluntary Organisation/Society managing
the school(With complete address)
3. School code :
4. Name with address of the school/institution for
financial assistance required
5. Objects and activities(give brief history of the
/society managing the school:)
6. Specific activities of the school for which financial
assistance is sought under the scheme
7. Whether registered under the Centra/State Board? : Yes No
8. Organisational structure,total staff.their roles and responsibilities,
staff turnover of educational
institute/school for which assistance is being
sought and the voluntary organisation/society
9. Governing Board/Managing Committe-number of
members,their role,meeting held and attendance,
their involvement in decision making of
educational institution/school and the voluntary
organisation/society concerned(List of members
may be enclosed)
10. Bank name :
11. Branch name :
12. IFSC Code :
13. Account No: :
14. Name and address of auditors,legal
advisors(including details of accounts)of voluntary organisation/society
15. Details of infra-structural facilities availible with
educational institution/school for whom,
assistance is being sought
a. Whether the building is rented or own? :
b. No. of rooms availible for classes and
Administrative purposes
c. Sufficiency of accomodation for reading :
d. Whether seperate rooms for science laboratory,library etc,are available. :
e. No.of teachers subject-wise already
working with their name,qualification etc.
(if needed attach sheets)
f. Number of children enrolled in respective
classes relevent to purpose for which
assistance is being sought.(at least 3 years
data be given)
16. Action Photographs about the school :
17. Sucess stories/testimonials/award/recognitions
and how the work of school has made difference to the individual,
family and for the community
18. Community/client involement in the academic
affairs pof school/educational institution
19. future plans and sustainability :
20. Audited balance sheet,income and expenditure
statement for the last three years of voluntary
agency and educational institution and school for
which assistence is sought
21. Annual repeot if any of VA/educational institution or school :
22. Inforamtion on existing funding sources with break
up grants,loans,and corpus received by VA and
educational institution/school for which assistance is being sought
23. Whether the educational institution/school is
receiving financial assistance for infrastructure
development of any kinds from any other source;if
so details thereof:
: Yes No
24. Amount required for additional :
Item Number Amount required* No. of children to be benefited
Science rooms
Computer lab rooms
Library rooms
Drinking water facilities
Hostels for girls
Hostels for boys
Educational facilities like ramps/labs for children with special needs
any other educational infrastucture requirement
25. Voluntary Organisation/Society's Share equal to
25% towards item 18 and commitment of
voluntary Organisation/society to provide the same:
26. Source of investment of voluntary organisations/
society's share given against item 18
27. Central Govt share equal to 75% reqiured against item 18 :
School Basic Details
28. Community of management :
29. Specify Category(Aided,Unaided) :
30. Category of Agency(corporate,charitable Trust Etc.) :
31. Whether Higher secondary,Secondary or Primary :
32. Specify No.& date of Recongition :
33. Specify the Registration No.& Date of Minority Status Certificate Obtained From the National Minority Commision :
34. Whether the agency has three years of existence : Yes No
35. Whether the school has three years of existence : Yes No
36. Whether Performance report enclosed with application : Yes No
37. No.of students in the school(for 2013-14) :
38. Source of commitment of the agencies to provide the amount :
39. Ground for grant :
40. Details of Proposed work to be done by using financial assistance.Write each item :
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