Application Form for Running RSTC/Spl. RSTC 1. NGO / SHG ...

Voluntary Agencies (NGO / SHG) Application Form for Running
RSTC/Spl. RSTC
1. NGO / SHG / Agency Name :
2. Registered under Indian Societies
Registration Act,1860
(Act XXI of 1860)
Trust Act
(Attach copy of the relevant documents):
3. Registered Address :
Telephone No :
Fax :
E-mail :
4. Whether the office of the Organisation
is Located in its own or rented building?
5. Objectives & Activities
(Attach brief Notes)
6. Agency has applied for running
AIE centres :

(a) Specify the area where the Project
will be taken up and No. of centres
to be run / (give area map)
(Dist. -Block- Habitation) :
7. Does the agency have any pervious
experience of running AIE centres
Educational Institutions / Residential
Schools for disabled children / KGBV
If yes, mention No. of years, No. of centres,
Location, Beneficiaries etc.,
(if the details are very large it can be annexed) :
8. a. No of students proposed to be admitted /
already functioning
b. Whether the NGO / SHG has already
been permitted to work by the
District Collector. If so furnish details :
9. Whether the institution has adequate
personnel to look after the project?
(Special teachers for teaching disabled children)
Brief Note :
9. Whether following documents attached :
(a) Constitution of Agency Yes No
(b) Constitution of the Board of Management
with particulars of each member
Memorandum :
(c) Latest annual report :
(d) Details of selection of warden preferably a
degree holder & support staff to run the
hostel (temporarily) :

(e) Audited accounts for the last three years :
(f) Along with a copy of the certified
Balance Sheet for the Previous year :
(g) List of additional papers, if any
(h) Additional Information, if any
Signature :
Name :
Designation & Stamp :
Person authorized to sign all documents on behalf of the agency.