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application
proforma
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1
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Name
and Structure of the institute
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2
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details
of Registration or other related information
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3
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Address
and Telephone No. of the Applicant
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4
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Institution's
foundation theme and its purpose;
ambit
of works and impacts of this in the field of environment
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5
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Foundation
year
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6
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Institution's
source of revenue
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7
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Details
of environmental conservation works being carried out by institution
and expenditure made
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8
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Remarkable
or credible impact due to above work
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9
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details
of Other prizes , received by the institution (if any )
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10
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details
of any contemplation , suggestion to be given by the Institution
and participation of the institution in the same
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11
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details
of Future planning and its credible impact on environment
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IT
IS DECLARED THAT THE PARTICULARS GIVEN IN THE APPLICATION ARE TRUE TO
THE BEST OF MY KNOWLEDGE AND INSTITUTION WILL ABIDE BY THE
CONDITIONS STIPULATED FOR THE AWARD. I WILL BE RESPONSIBLE FOR
ANY WRONG INFORMATION FURNISHED.
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NAME:
SIGNATURE:
ADDRESS:
PHONE
NO.:
FAX
NO.:
E-MAIL
ADDRESS:
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CONDITIONS
FOR APPLICATION:
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Only one application will be accepted from the institution.
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Application received after due date for submission of application and incomplete application shall not be considered.
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Decision of the
Chhattisgarh Environment Conservation Board regarding award shall be final and binding.
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Application
shall be submitted to:
MEMBER
SECRETARY
CHHATTISGARH
ENVIRONMENT CONSERVATION BOARD
H.No. 1, TILAK NAGAR, SHIV MANDIR CHOWK,
MAIN ROAD,
AVANTI VIHAR,
RAIPUR
(C.G.)
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