PART A: A. About the Nominee
Name of the nominee:
Age of the nominee:
Communication address of the nominee:
City:
State:
Email ID of the nominee:
Contact number of the nominee:
Name of the nominator:
Email ID of the nominator:
Contact number of the nominator:
Brief about the nominee(up to 1250 characters)
B. About the Initiative(s)
Title of the initiative(s):
Thematic area/s of the initiative(s):
If Others, please specify:
What was the need for the initiative(s)? (up to 1000 characters):
What are the objectives of the initiative(s)?
(Please also mention how these objectives align with national and global climate action targets.)
(up to 1250 characters) :
What are the key activities as part of the initiative(s)? What is the current status of the activities?
(up to 1250 characters) :
Where are the initiative(s) implemented/ planned to be implemented?
(Please specify urban local body/ municipality, district, state, and country as well.)
:
What is/ was the nominee’s role in the development/ implementation of the initiative?
(up to 1250 characters)
:
Are there any partner organizations for implementing the initiative(s)? If yes, please specify the name and role of the organization(s).
(up to 1000 characters)
:
What are the intended and unintended outcomes and impacts of the initiative(s)?
(up to 5000 characters)
:
What is the total number of beneficiaries that the initiative(s) has reached/ aims to reach?
(Please mention the category of beneficiaries i.e., whether individuals, (men, women, youth, farmers, etc.), households)
(up to 1000 characters)
:
No. of direct beneficiaries impacted:
No. of targeted beneficiaries:
No. of indirect beneficiaries impacted:
What are/ would be the impacts of the initiative(s)?
(Please mention the visible impacts (socio-economic, environmental, etc.) for different stakeholder groups distinctively. Influence on policy/ regulations could be mentioned as well.)
(up to 1000 characters)
:
Please mention additional information about the initiative(s), if any.
(up to 1000 characters)
:
Declaration
I / We certify that all information provided in this form is correct and true to the best of my/our knowledge. I / We am / are willing to provide any supporting documentation / evidence that may be required to verify the information provided herein and I / We agree to abide by the decision of JSW TOI EARTH CARE AWARDS in all matters relating to the Award.
Yes, I agree
