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সাময়িক আবাসিক গৃহ

সাময়িক আবাসিক গৃহ

চাকৰিজীৱি মহিলা থকা-খোৱা ব্যৱস্থাৰ বাবে ব্যৱস্থাৰ আবাসিক আঁচনি অৰু কোনো স্বামীৰ দ্বাৰা নিৰ্যাতিতা-পৰিত্যক্তা নাৰীৰ থকা-খোৱা ব্যৱস্থা কৰিবলৈ সাময়িক আবাসিক গৃহ কেন্দ্ৰ আদি আঁচনিসমূহো কেন্দ্ৰীয় সমাজ কল্যাণ পৰিষদে স্বেচ্ছাসেৱী স্ংগঠন সমূহলৈ অনুদান আগবঢ়াই আহিছে। উক্ত অনুদানৰ বাজেট বৰাদ্দ আৰু প্ৰ-পত্ৰৰ নমুনা তলত দিয়া ধৰণৰঃ

ওপৰোক্ত অনুষ্ঠান সমূহৰ আবেদন পত্ৰৰ বাবে প্ৰতিবৰ্ষতে ৰাজ্যিক সমাজ কল্যাণ পৰিষদৰ জৰিয়তে কেন্দ্ৰীয় সমাজ কল্যাণ পৰিষদৰ আবণ্টিত আঁচনিৰ ধন আঁচনিৰ ধন অনুযায়ী আবেদন আহ্বান কৰে।

SHORT STAY HOME ৰ বাৰ্ষিক বাজেটৰ পৰিমাণ ৪,০১,৩৫০/- টকা ধাৰ্য্য কৰা থাকে আৰু ইয়াৰ ভিতৰত আবৰ্ত্তক শিতানসমূহ যেনে কৰ্মীৰ দৰমহা, ঘৰভাৰা, অন্যান্য, ঔষধ আৰু স্ংস্থাপনৰ উপৰিও ৫০,০০০/- টকা অনাবৰ্ত্তক সামগ্ৰীৰ বাবে দিয়া থাকে।

SCHEME OF SHORT STAY HOME FOR WOMEN AND GIRLS

APPLICATION FORM

Note: 1. The application should be submitted in triplicate to the child Development Programme Officer (CDPO) of Dist. Women and Child Development Officer or Distt. Social Welfare Officer of the project area.

2. Applications either incomplete or without all enclosures will not be entertained.

3. Parts A & B should be completed by the applicant Organization.

Part-A-The Organization

1. Name and full postal address of the head-office of the organization

District:

State:

Pin Code:

2. Telephone No. with STD Code:

3. Fax No:

4. Do the byelaws of the NGO permit it to receive Govt. grants and implements women’s programme in the proposal project area?

5. Objectives of the organization:

6. Brief history of the Organization:

7. Whether registered under Indian Societies Registration Act (XXI of 1860)if so, give the number and date of registration:

8. Whether the Organization is of all Indian Character: If yes, give the address of its branches in different states including the State Branch which will run the Short Stay Home with Phone No., Fax No., etc.

9. Whether Organization is located in its Own/rented building?

10.

Name of Activity

Coverage

Expenditure

 

Men

Women

Children

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Summary of financial status of the organization in the last year.(Rs. In Lakhs)

Year

Income & Exp.

Acctt.

Receipt and

Payment Acctt.

Surplus

Deficit

 

 

 

 

 

 

 

 

 

 

12. Details of received from Central Govt./State Govt. and other Govt. agencies in the 2 years:(Rs. In Lakhs)

Sanction Order No.

Date

Amount

Scheme

Address of

Funding agency

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. Details of Foreign contribution received during last 2 years:

Country

Organization

Purpose

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. Details of office bearers of the organization:

Sl. No.

Name & Address

Male/ Female

Age

Post

Qualification

Profession

Annual Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. Details of employees of the organization:

Sl. No.

Name & Address

Male/ Female

Age

Part/ Full time

Qualification

Post

Monthly salary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. Details of Managing committee members of the organization

Sl. No.

Name & Address

Male/ Female

Age

Qualification

Profession

Monthly salary

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Part-B-THE-PROPOSAL

1. Full Address of the proposed location of the short stay home:

District:

Block:

Pin code:

Telephone No. with STD code:

2. Whether the location is a District H.Q, Block H.Q, Tehsil H.Q. or village.

3. Accomodation available for the short stay Home:

 

No. of Rooms

Total Areas (sq. ft.)

Room

 

 

Kitchen

 

 

Toilet

 

 

Store

 

 

Varandah

 

 

Open Space

 

 

Total

 

 

4. Is it rent-free accommodation:

5. Classification of proposed beneficiaries:

6.

Type of Problem

No. of Women (Proposed beneficiaries)

In moral danger

 

Victim of Rape

 

Cruelty by family members

 

Deserted by Husband

 

Family Discord

 

Other (Please Specify)

 

Total

 

7. No. of Family Counseling Centres in the District:

8. Is your NGO running any Family Counseling Centre?

9. No. of destitute Homes run by the State Govt. in your District:

Date:                                   Signature of Secretary/President

 

I have carefully studied the scheme, its guidelines, terms & conditions of the sanction stipulated by Central Social Welfare Board, and I, on behalf of the institution undertake to abide by these conditions.

 

Signature……………………………………………………

Name……………………………………………………….

Designation………………………………………………..

Seal………………………………………………………..

 

Date:

Place:

Note: Please ensure that all necessary documents are attached with his application form.

উৎসঃ কেন্দ্ৰীয় সমাজ কল্যাণ পৰিষদ।

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