NOMINATION FORM - CSR EXCELLENCE AWARDS 2017

Application Instructions

Submit separate application form for each category.

Applications must be submitted in MS Word Format.
Please use Calibri Font with Font Size as 12.
Respond to all the questions within the word limitations indicated.
Enclose Company Logo as attachments (600x600 dpi and EPS; PNG;
CDR format)
Supplementary materials such as photos, annual reports, video clips,
testimonials, etc. are optional and should be enclosed as attachments.
Jury may request supplementary material during the judging process.
Jury may ask for additional documents for verification; however
applicants are responsible for the validity of information.
Companies submitting materials for awards authorize the organizer to
use these at both the Awards Ceremony and in Organizers publications
and activities.
Any incomplete applications or failure to follow established guidelines
may lead to disqualification.
The nomination fee is INR 5,000 per category.
The submission deadline is April 20, 2017.

AWARD CATEGORY
Select Award Categories: CSR Company of the Year | CSR Leader of
the Year | CSR Practice of the Year | CSR Project of the Year in
Education; Environment; Women Empowerment; Livelihood; Poverty
Alleviation; Skill Development; | CSR Project of the Year (Industry-
wise): Healthcare; Cement; Energy/Power; Banking & Finance; Iron

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 & Steel; Information Technology; Media; Oil & Gas | CSR
Implementation Agency of the Year | NGO of the Year | Social
Entrepreneur of the Year | CSR Campaign of the Year
Mention Category Applied For:

NOMINEE INFORMATION
Mention Nominee Details:
Name of Organization:
Address:
Phone Number:
Size of Organization (Number of Employees in India):
Annual Turnover (in Rupees):
Annual CSR Budget (in Rupees):
Details of the Contact Person
Name:
Designation:
Email ID:
Mobile Number:
Details of the person/(s), who will come to receive the award in the award
ceremony, if you are declared winner.
Name:
Designation:
Email ID:
Mobile Number:

QUESTIONNAIRE
1. Program/Project Overview (500 words maximum):

2. Stakeholder Engagement (300 words maximum):

3. Impact (1500 words maximum): This section deals with the impact of
your program. Please support your entry with both qualitative and
quantitative evidence testimonials, evidence from employees and
business managers, beneficiaries and partners.
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Describe how success of the project is measured and the results have been
achieved to date. Explain how success and results are reported and
documented.

SUBMISSION INFORMATION

Mark the email subject heading as: CSR APPLICATION

Send it by email to: ashutosh@mediabytes.in

** Thank you for your application and wish you good luck! **

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