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Category I: Community based Climate Action

Name of the organisation

Brief about the organisation

(upto 100 words)

Category of the organisation

Government body

NGOs/ Trust

Autonomous/ Apex bodies

Community based organisations

Private companies

Multilateral agencies

Academic institutions

Others, please specify

Country of registration

Registration number (if applicable)

Registered address

Name of contact person

Designation

Official Email ID

Contact number

About the Project

Title of the project

Thematic area (Multiple Options can be selected)

Natural resource management

Biodiversity conservation

Sustainable agriculture & allied livelihoods (promotion/augmentation)

Sustainable harvesting

Water security

Food security

Climate resilient infrastructure

Ecosystem conservation

Climate-induced disaster management

Climate induced migration

Health & nutrition

Energy supply & conservation

Climate friendly/aware supply chains

Education

Gender mainstreaming

Ecosystem conservation

Others, please specify

Rationale of the project

( upto 250 words)

Project location and geographical coverage

( upto 250 words)

What is your organisation's role in the project?

Implementation support

Funding support

Others, please specify

Are there any partner organisations for implementing the program?

Yes No

What are the roles of partner organisations?

Name of the partner organisation

Organisation Role Implementation support Funding support Others, please specify

If Others Organisation Role, please specify

Number of direct beneficiaries

Please select the category Individual Household

Number

If Other Category, please specify

Number of indirect beneficiaries

Does the intervention include members of the marginalized group as beneficiaries?

Yes No

Describe the nature of inclusion

Was the solution/ project/ initiative deployed within the last five years (i.e. between January
2018- March 2023)?

Yes No

Project start date

Project end date

Project duration ( in months)

Project objectives
(upto 200 words)

Key activities under the project

(upto - 200 words)

Role of the community in the project

(upto 200 words)

What are the expected outcome and impact of the project?

(upto 200 words)
 Linkages with SDGs (multiple options can be selected)

Goal 1: No Poverty

Goal 2: Zero Hunger

Goal 3: Good Health and Well-being

Goal 4: Quality Education

Goal 5: Gender Equality

Goal 6: Clean Water and Sanitation

Goal 7: Affordable and Clean Energy

Goal 8: Decent Work and Economic Growth

Goal 9: Industry, Innovation and Infrastructure

Goal 10: Reduced Inequality

Goal 11: Sustainable Cities and Communities

Goal 12: Responsible Consumption and Production

Goal 13: Climate Action

Goal 14: Life Below Water

Goal 15: Life on Land

Goal 16: Peace and Justice Strong Institutions

Goal 17: Partnerships to achieve the Goal

Does the intervention leverage technology to deliver or scale impact?

Yes No

Describe how they are using technology

Have you conducted any impact assessments? (If yes share the documents as well)

Yes No

Please share other project documents such as DPR, Program brochure, etc.

Any other information about the program

(upto 200 words)

Declaration
Yes, I agree
(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.

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