Part - I Key Details
Category : Theme :
if others, pl specify:
Type of Environment Communication Initiative :
if others, pl specify:
Funded By :
Initiative Title :
Initiative Start Date : Initiative End Date :
Part - II Description
Initiative Purpose and Goals : Description
(Please describe in max 250 words the initiative)		 :
Target Audience
(Please mention the initiative target group)		 : Medium Used :

if others, pl specify:
Activity Details
(Frequency and duration if print or electronic media used) 		: Achievements, Outcomes and Impact considering the evaluation criteria
(Achievements: Extent to which initiative goals were achieved; Outcome: Results of initiative implementation; Impact: Initiative influence on target audience)
(Submit outreach data, if any, kindly attach relevant documents i.e. activity reports, ppts, documentation, collaterals etc in Part III) 		:
Sustainability
(How initiative has been sustainable over the years and future sustainability) 		: Elaborate why your entry is a game changer?
(Is it innovative? Can it help sensitise & engender positive behaviours? Has it galvanised responsible action for a sustainable future? Kindly attach relevant documents, testimonials etc. if any, to show change effected by initiative in part III). 		:
Part - III Documents (upload here)
Photographs
(Max 4 photos can be uploaded in jpeg, png and gif formats only) 		: News Coverage
(Max 4 news clippings can be uploaded in jpeg, png and gif formats only)		 :
Videos
(Please paste the film link here i.e. YouTube or Vimeo, etc) 		: Audios
(Please paste the sound cloud link etc.)		 :
Other Documents
(Max 4 Collaterals, PPT, Report or other documentation) 		: Full Name of Awardee
(As it should appear in the citation and trophy, if awarded)
Part - IV Entrant Details
Name : Designation :
Organisation : Address :
Gender : City :
State : Country :
PIN Code : Mobile :
Phone : Fax :
Email : Website :

Entry Type Date Fee
Early Bird Thursday, September 15, 2016 FREE
Final Call For Entry Saturday, October 15, 2016 INR 1000
GALA AWARD NITE: Friday, February 17, 2017

I hereby confirm that the particulars provided above are true to the best of my knowledge. I am also the authorised representative/ person to apply for this award.