KOLKATA GIVES NOMINATION FORM

QUESTIONNAIRE

Basic Information:

1. Name of the Organization:

2. Official Address:

3. Phone Number:

4. Email address:

5. Website (if any):

6. Name of Head/Chief Executive Officer:

7. Number of Staff/Volunteers:

8. Year of Starting Welfare Activity:

9. Location and Area of Operation:

10. Is your organization a Trust/Society/Section 25 company:

11. Is the organisation registered with: - Guide star India/ Give India / Credibility Alliance?

12. Total Annual Budget for 2013-14:

13. Does your organization program qualify as CSR in terms of the latest amendment of the Companies Act?

14. How will participating in ‘Kolkata Gives’help you further your objectives?

Genesis:

1. Purpose of Establishment, Vision and/or Mission Statement:

2. A brief description of the Welfare Work done by the organization since its inception (Please also include approximate information on the number of beneficiaries):

3. What are the innovative and original aspects of your project?

4. What are the mechanisms in place for regular monitoring and evaluation of your programs?

5. Describe the challenges your organization faces in meeting the needs of the community it serves?

6. Explain both the qualitative and quantitative indicators for success/impact on all Stake holders and how the indicators are measured.

Governance:

1. Please provide a list of all Board Members/Trustees, their professional background and age. Please also include information about their relationships, if any, With the founder or the management of the organisation.

2. Describe your Administrative Pattern?

3. Please provide a list of awards, accreditations or memberships won by your organization (if any):

Financial Sustainability, Resource Mobilization, Financial Management:

1. Please provide names and funding details of major donors who have supported you.

2. What are the internal control systems to ensure appropriate and proper utilization of financial resources for the programs of the organization?

3. What is the ratio of program to operating costs in your organisation?

List of Annexures to be submitted:

Please provide one copy (soft or hard) of each of the following:

1. Trust deed/ MoA and AoA constitution

2. Copy of 12A

3. Audited accounts for 2013-14: Balance sheet and income and expenditure statement.

4. Organizational brochure