APPLICATION FOR ASSISTANCE FOR INSTITUTIONAL SERVICES FOR WELFARE OF DESTITUTE CmLDREN 1. Name of the institution. 2. Address. 3 Copy of the constitution and the list of members of the Executive Committee. Date of registration under Societies Registration Act.4. Present capacity of institutional Services for children.5. (a) Nwnber of children at present served. 6 (b) Nwnber of children proposed to be admitted now. 7 Age range of children. Boys or girls or mixed.8. 9 Types of children serviced: (a) Destitute children: (b) Delinquent children committed Wlder cow't orders. 10. Type of Accommodation: i) Type of building. ii) Average floor area allowed to each child for sleeping. ill) Whether cots are used or whether children sleep on floor. NatW"e of services ofl'ered:II. a) Boardingb) Education c) Vocational Training. d) Recreation c) Case work services 1) Medical and g) Other services nature of rehabilitation services. 11. A. Approach to organisation of services: a) Through domlitories b) Cottage system Nature of personnel employed and their training a) House Mother 12. b) Donnitory incharge c) Cook and helper d) General Education Teachers e) Vocational Instructors f) Case workers (State qualification and experience) g) Recreation Wocker h) Medical Officer (part-time) i) Superintendent (State qualification and experience) j) Any other. 13. a) Existing level of recwring expenditure per child per for various items like food. Clothing. bedding. health check-up and medicine, education (including books stationery etc.) Vocational training, recreation etc. Rent for acconunodation (per child per month average). 14. Expenditure on salaries of personnel. IS. Nature of supervision (by paid or voluntary personnel) 16 Capacity of expansion of sernces. a) Is accomn1odation avai1abl~ for taking rnor~ children? b) Number of additional children that could be provided with services. 17. Assistance received by the organisation dW'ing last year from a) Central Govenunent b) State Government c) Central Social Welfare Board d) State CoWlcil We1fare Advisory Board e) Private donation f) Any other soW'Cc 18. Copy of the audited statement of accoWlts for last fmancial year. average number of children present per month during the year. Also state the 19. Assistance now sought for taking care of additional children a) Recwring assistance b) hlitial non-recwring assistance c) Building 20. Amount to be contributed by the organisati_on 21. Any other infOIll1at10n.
