Section 1 – Nomination |
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Nomination by |
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Section 2 – Nominee Details |
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Name of the SHG |
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Year of formation |
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Tenure |
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Name of the Chairperson of the SHG |
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Mobile number of the Chairperson / Alternate contact number |
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Offical e-mail id of the SHG |
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Full address of the SHG |
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Pincode |
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Has the SHG received any other awards? |
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If you have answered “Yes” above, please provide the name of the award, name of the awarding body / institution and year. |
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Online Presence (Provide links, if any) |
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Please provide details of the SHG members |
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Section 3A – Please provide details of references |
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Section 3B – Please provide details of nominator |
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Name of the nominator |
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Name of Organisation / Group / Institution |
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Designation |
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Contact number |
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E-mail id |
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Section 4 – Nomination Form (Please provide information for the last 12 months) |
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"If you face any difficulty filling out Section 4 of the form, you can print it, complete it manually, and then upload the duly filled form using the upload button."
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Number of people benefitted by the SHG |
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Total corpus amount of SHG |
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Loan repayment rate of the SHG |
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Narrate how did you create an exemplary and lasting impact on individuals or groups under challenging and adverse circumstances? How did you demonstrate an exemplary processes to bring about positive changes in children’s growth and development, adolescent girls and women. Justify (max 300 words) |
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Narrate how you used innovative technique(s) to improve efficiency to address issues and real-time challenges in the course of work (max 300 words) |
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Narrate a story of change wherein you have contributed to bringing positive change in the community. Justify (max 300 words) |
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Section 5 - Upload Document |
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Section 6 - Declaration |
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I hereby declare that the information given above and in the enclosed documents is true to the best of my knowledge and belief.
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