APPLICTION CUM MONITORING FORM FOR GRANT-IN-AID

FOR INTERGRATED PROGRAMME FOR STREET CHILDREN

(For 1st installment and new cases)

PART - A

1. Financial year for which grant-in-aid Is applied :

2. Name of Organisation :

3. (a) Nature of Project :

(b) Date of commencement of the Project :

4. Date of Registration of the organization :

5. Address of Registration Office :.....................................................

.......................................................................................................
(STD Code)Tele. No............................
(STD Code)Fax No................................Email..............................

6. (a) Complete Address of location/locations where

programme/project/scheme is being implemented.......................
......................................................................................................
.........................................................................................................
.......................................................................................................
(STD Code)Tele. No...........................
(STD Code)Fax No............................. Email.............................

(b) Nearest Railway Station/Bus Stand.................................

7. Whether building is

OWNED RENTED ON LEASE DONATED

(Please indicate 9 against appropriate box)

8. (a) Is the building being utilised exclusively

for this program ? [Y / N]

(b) If no, provide details of usage.................................................

9. (a) Area of building :.............

(in sq. meters)
(b) Number of rooms:...........

10. Whether separate project-wise accounts have been :

maintained for grants sanctioned earlier. [Y / N]

11. (a) Whether principle of joint operation of banks:

accounts is being followed ? [Y / N]
12. Details of bank accounts in which grant-in-aid released during
previous financial year.

Sr Grant-in- Sanctio Date Recurrin Non- Bank Name person

. aid for n letter d g recurrin A/c and operativ
N financial number Amount g No. Addres e to joint
o. year Amount s of account
bank
1.

2.

13. Whether the Statements of Accounts submitted :

alongwith the application
[Audited / Unaudited]

(Please indicate 9 against appropriate box)

14. The amount of support sought from the Ministry

for recurring grant-in-aid

.........................................................................................................
.........................................................................................................

(a) Recurring ..................................................

(b) Non-recurring............................................
(c) Total ..........................................................
15. Whether list of beneficiaries enclosed as per form-I [Y / N]

16. Whether list of managing committee enclosed as per form-II

[Y / N]

17. Whether the list of employees enclosed as per from-III [Y / N]

18. Whether copy of Annual Report (latest) enclosed [Y / N]

(Please indicate 9 against appropriate box)

List of Documents to be submitted alongwith Application for 1st
installment new case.

a. Accounts in 4 parts for the project for which grant-in-aid is

sought and the oraganization as a whole.

(i) Income & Expenditure Statement.

(ii) Receipt & Payments Statement.

(iii) Balance Sheet.

(iv) Auditors Report.

b. Activity / Annual Report of The Organisation for the previous

year.

c. Budget estimate for the project for current year.

d. Details of Beneficiaries on form-I

e. Detail Managing Committee on form-II

f. Details of Employees on form-III

g. Copy of Registration Certificate.

h. Memorandum of Association / bye-laws / Articles.

i. Utilization certificate in respect of grants released in the proving

year.
Note 1 : In the case of new projects accounts should be audited and
the accounts submitted for the last (preceding) two year.
Utilisation Certificate dose not apply.
 SHREET CHILDREN

PART - B

1) Details relating to beneficiaries

Number of Number of No. of No. of drop

street street children at outs during
children on children end of the the last one
the rolls as enrolled year/date of year.
on 1st April during last application.
of the year.
previous year
1 2 3 4
2)

Background of street children

Orphans From Run-aways Other Total

extremely due to s
poor mistreatment /
families Abuse by
who cannot parents/relativ
maintain es
them
1 2 3 4 5

3)

Reasons for drop outs

Employed Reintegrated Other reasons total
with family (including
those shifted
to other
homes/center)
1 2 3 4
4) Details of sanctioned received in the preceding financial year

a) Sanction Nunber and date :

Sanction No. Date

b) Amount sanctioned :

Recurring Non-recurring Total

c) Amount utilized :

Recurring Non-recurring Total

5) Details of facilities provided in project centre

a) Nutrition / Meals Provided :

Once a Day Twice a Day Not

Provided
b) Vocational Training : [Yes / No]

If Yes details to be given below

Sr. Trade Duratio No. of No. of Please average

No. n of Trainee trainees mention incode
Trainin s in the gainfully nature of per
g last one employe follow up month
Year d out of after earned
them training by
is successfu
complete l trainees
d I col(2)

1 2 3 4 5
1 Carpentry
2 Plumber
3 Electrician
4 Computers
5 Others

c) Please indicate linkages maintained with potential

employers for absorbing the beneficiaries of Vocational training.
d) General Education : [Yes / No]
If Yes details to be given............................................
..........................................

e) Recreation : [Yes / No]

If Yes details to be given..............................................
.................................................

f) Nature of night shelter provided [Yes / No]

if any, giving number of residents
on an average per night.........................................................
............................................................
............................................................

g) Nature of medical care provided [Yes / No]

indicating periodicity of routine
check-ups................................................................................
...............................................................................................

h) Please indicate details of Counselling [Yes / No]

services provided to street children
and their parents to facilitate reintegration
with families and otherwise.................................................
............................................................................................

i) Are there any arrangements for banking [Yes / No]

and credit facilities for street children ?
If so details be given...........................................................
............................................................................................

j) Are there any arrangements for safe [Yes / No]

keeping of earnings / belongings of
street children in the center ? if so
details be given..................................................................
 k) Is any contribution / payment taken [Yes / No]
from any street children for food,
medicines, etc ? if so details be given..................................
...........................................................................................

l) Please indicate linkages maintained with other institutions /

organizations to meet the gap in facilities provided in its
own center.

(1) Education arrangement

(2) Food Nutrition

(3) Health check up

(4) Tour arrangement

6) Details of Awareness Programmes initiated [Yes / No]

please give details of seminars / camps /
special functions organized / participated
by the organization in the last one years .......................................
.........................................................................................................

7) Inspection, if any, conducted by State Govt. /

any other.

Sr. Date of Inspection Whether

No. Inspection Agency Inspection Report
was sent to the
Oragnization
 Part - C
Organization Fund Flow

FOR THE ORGANIZATION AS A WHOLE FOR THIS PROJECT

Year Previo Current Year Previo Current

preceding us Year preceding us Year
the financial year budget the financial Year budgete
year of (for ed/ year of (for d/ actual
Grant-in-aid New actual Grant-in-aid New
assistance Cases) assistance Cases)
indicated as indicated as
SI No. 3(c) SI No. 3(c)
Part-A Part-A

I Financial Year
II total INCOME, of which
(i) Funded by office bearers,
donations from private sector.
(ii) Funded by foreign contribution

(iii) Funded by by local bodies and

public sector Organization / State
Govt.
(iv) Grant from Central Govt. (Please
indicate from each Ministry/ Deptt./
CAPART separately
(v) Beneficiaries contribution
(vi) Miscellaneous inco,e
(vii) Any Other sources not mentioned
above (specify)
Total EXPENDITURE, of which
(i) Recurring
(ii) Non-recurring
d) Details of Expenditure on : Year Previo Current Year Previo Current
preceding us Year preceding us Year
the financial year budget the financial Year budgete
year of ed/ year of d/ actual
Grant-in-aid actual Grant-in-aid
assistance assistance
indicated as indicated as
SI No. 3(c) SI No. 3(c)
Part-A Part-A
(i) Salaries and Wages
(ii) Rental :
(a) Building
(b) Furniture & Fixture
(c) Plant & Machinery
(iii) Traveling, daily, etc. allowances
(iv) Other Administrative Costs
(v) Expenditure :
(a) In Cash
(vi) Expenditure on beeneficiaries :
(b) in kind :
i) Food
ii) Uniform / clothing
iii) Medicines
 iv) Transport facilities
v) Recreation / Games
vi) Misc.
(vi) Material costs incurred by the
orgn :
(For imparting vocational Training)
a) _______________
b) _______________
c) _______________

(viii) Cost per beneficiary