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ONLINE NOMINATION FORM

Nomination Process is completed in 2 Steps

Step-1 Requires information about the nominee and why the nominated Entity should be awarded this honour :.

Step-2 Requires testimonilas from credible external (2) & internal (1) entities certifying Nominee's Social Justice initiatives

STEP-1

Date:

NOMINEE

Name :

Date of Birth :

Home Address City/State/Zip :

Mobile :

Email :

Current Occupation :

Company/Organization Name :

Title/Position :

Business Address City/State/Zip :

Phone :

NOMINATOR

Name :

Company/Organization Name :

Title/Position :

Business Address City/State/Zip :

Phone :

Email :

AWARD CATEGORY / SECTOR

TO BE FILLED BY NOMINATOR

Please explain briefly, in not more than 100 words, why the nominated Entity should be awarded this honour :

TO BE FILLED BY NOMINEE

INFORMATION PERTAINING TO CRITERIA

Please Upload Curriculum Vitae in .doc or .pdf format (Max. File size 1 MB) :
(Curriculum Vitae should describe the credentials of community service. In case of first time initiatives - statement to that effect/ prior history of involvement in voluntary work, trigger for social action, details of any positions of responsibility held like NSS etc.)

STATEMENT OF PURPOSE

Please give a background of your work history :

The following points must be included in the write up:

How does your action symbolize "Social Justice and Citizen action"? Briefly outline your point of view with regard to how you represent the cause of being "Socially Responsible"
Background/Need for the Action taken: Describe the situation or problem that existed in the community or similar. Explain the problem which you helped to address.
What was the Objective? What were the Actions taken to achieve the Objective by you? Describe the actions taken to achieve the same and resources involved, duration, level of impact of the actions taken.
What were the Outcomes/ Results? What kinds of benefits were gained? Describe the advantages the community or targeted cause gained as a result of your efforts .
What were the challenges overcome by you to focus upon this cause? Describe the kind of constraints or problems that were faced by you and how they were overcome
The write up, at appropriate places, must also give relevant facts and details like,
- Number of people directly affected
- Number of volunteers involved in the program
- Amount of funding raised or goods and services donated or leveraged
- Percentage of pre-tax profits donated to charity
- Charitable activities conducted as an individual

Please keep the write up under 500 words.

Please give a brief write up on a social justice issue of importance that you hold close to your heart in about 500 words. Also mention how you as an individual along with others can work towards the issue :

Together as ONE we can RIGHT every WRONG

How my Small Actions have been contributing towards making a Big Difference? Explain in not more than 500 words.

Additional information pertaining to criteria :
(Include any additional information you feel is important for consideration of your nominee. List awards, honors received publications or articles supporting service to their profession, industry or community)

I agree to abide by all the terms and conditions laid down by iCONGO

I, as the applicant/nominator, validate all the information submitted by me/the nominee about my/ his/her social justice and citizen action initiatives and hence nominate myself/her/him for the Karmaveer Puraskaar.

The Nomination form will not be accepted until the Testimonial Page is submitted.

Co - Promoters
Over the Years

Co - Promoters Over the Years

Co - Promoters
Over the Years