Ministry of Human Resource Development Department of Women and Child Development, New Delhi (to be submitted in duplicate) Scheme of Short Stay Home for Women and Girls APPLICATION FORM (Note: Application received in an incomplete form will not be entertained) Part- I (TO BE COMPLETED BY THE APPLICANT) 1. Name of the Institution/Organisation 2. Objectives of the Institution/Organisation 3. Brief history of the Institution/Organisation and of its objects and activities. 4. Whether recognized by the State Government 5. Whether registered under Indian Societies Registration Act (Act XXI of 1860) If so, give the number and date of registration. 6. Whether the Institution/Organisation is of all India Character? if so give the nature of its all India Character. 7. Whether located in its own/rented building. 8. Whether the project is likely to be assisted by some other official or non-official source. If so, give detail thereof. 9. Justification for the project indicating its important features which entitle it to central assistance. 10.Total estimates expenditure on the Short Stay Home for one year: i. Non-recurring..........Rs ii. Recurring..............Rs Period for which recurring assistance is required. 1. Amount of grant requested: Estimated Expenditure: i. Non-recurring............Rs. ii. Recurring.............Rs.. Period for which recurring assistance is required. 1. Is accommodation available for running the Short Stay Home or temporary shelter is proposed to be improvised? Proposed location of short stay home with full address. 2. Whether the Institution is in a position to meet excess expenditure? If so, indicate the sources. 3. List of papers/statements to be attached (in duplicate) 4. prospects of a note giving aims and objects of institution/organization. a. Constitution of the Institution/organization. b. Constitution of the Board of Management with brief particulars of each member.
