Part - I Key Details
Category
:
Individual
Media-Newspaper, Magazine, Radio, Community Radio, Television & Online
Filmmaker
Advertising Agency
Developmental Organisation
Civil Society Organisation
Educational Institution
Theme
:
Climate Change Communication
Water Sanitation and Hygiene (WASH) communication
Biodiversity Conservation Communication
Others
if others, pl specify:
Type of Environment Communication Initiative
:
Communication Programme
Campaign
Public Service Announcement (PSA)
Advertisement(s)
Jingle
Film
Others
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
:
Print
Television
Radio
Online
Film
Traditional Media
Interpersonal Communication
Others
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
:
Male
Female
Other 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.