GLOBAL YOUTH AWARD 2016 NOMINATION FORM Mail the completed form at worldyouthsummit2016@gmail.com . www.wys2016.org
Please read the following instructions / guidelines:
Please ensure that filled in text is not repeated in the responses against the items in Part I, Part II and Part III. Please fill the form liberally and attach extra documents and links so that the expert panel gets adequate information about your project in the best possible manner. Questions marked with asterisk * are mandatory. However, we recommend filling all fields. Please provide additional information, documents etc. in support of your idea /project/ application/ solution /innovation. Nominated project must be implemented on the ground for at least 1 year. Please provide 3 testimonials in support of your idea /project/ application/ solution /innovation. It is mandatory to provide an audio-video of 3-5 minutes about your nominated work. It is mandatory to provide at least a list of beneficiaries with contact details about the applicant’s nominated work (25 beneficiaries at least with mix of gender, caste, community diversity). Part I - Overview 1. Nomination category Advocacy & Empowerment
Education Environment Health Livelihood, Skill Development, Entrepreneurship & Employability Technology for Development Women Empowerment Youth Development & Empowerment Culture & Heritage Social, Gender & Financial Inclusion
2. Name of the project(in English): 3. Name of the project in original language: 4. Project launch since 5. Project location (Community, village, panchayat, block, district) 6. URL (If Online): 7. Project summary (50 words) 8. Short description of the project: (100 Words) Part II - Implementation Details 9. The background idea / reason / necessity to implement the project (Max. 100 words) 10. Implementation Methodology (Max.100 words) 11. Community participation & engagement in implementing the project? (Max. 100 words) Part III - Project Details 12. Chronology* a. Current Status of the project b. Launch Date of the project c. Completion Date of the project
d. Other Important dates & events during the journey of the project: 13. What has the project delivered / solution provided to the beneficiaries? (Complete list of deliverables to the end user /target group through this initiative) (Max.100 words) 14. Describe the sustainable model (Not more than 100 words) 15. Quantitative & qualitative impact of the project in diverse locations and people. Max. 100 words) 16. Partners, collaborators, agencies involved in developing, implementing and running the project? (Max. 100 words) 17. Provide some user experience on how your project has impacted their life? (Max. 100 words) 18. How is your project unique? (Describe the Uniqueness of your Innovation in terms of Originality of Idea / Method/ Development Model/ Technology / Application / Implementation that your product/project has which makes it different). (Max. 200 words). 19. How cost effective and affordable to deploy and run the project if it is implemented / replicated in other location? (Max. 100 words) 20. Can the project be easily scalable and can be expanded? 21. What is your vision of “Youths for Sustainable Development� ?(100 words) Part IV - Producer (Individual/Organization) information 22. Name of Applicant Organization (Nominees)* 23. Contact Person* 24. Street Address* 25. City*
26. Post Code* 27. State* 28. Country* 29. Mobile, Telephone, Fax* 30. Email(s)* 31. URL/Website Heads, Team Members, Partners, Clients, who have significantly contributed* S.No.
Name
Organization
Designation
Phone
Role
Note: 1) Applicant may add any additional testimonials, press coverage, certificates etc. that will help the jury panel to judge the projects effectively and qualitatively. 2) Last date of application received will be September 30, 2016. 3) Nominal Registration Fees will be apply for Nominated individuals / Organizations.