Department of Science & Technology
and Biotechnology, Government of West Bengal

Meghand Puraskar

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*   Mandatory Field
Name of the Applicant
Date of Birth
Gender
Mobile no.
Alternate Mobile no.
Email ID
Alternate Email ID
1. Organization Details:

Organisation Type *
Name of the Organization
Date of Establishment: *
Registration under *
Date of Registration *
Registration no *
Address of the organization *
State *
District *
City / Town / Village *
P.O. *
P.S *
Pin code *
Telephone (office) *
Fax no. *
email ID (office) *
website (if any) *
2. Head of the Organization
Name *
Designation *
Total no. of Partners *
Total no. of Employees *
Main source of fund for operation*
Brief description of the functions of the Organization (in 500 Characters)*
Region of operation*
Goal of the organization: (in 200 Characters)*
Achievements of the organization in the field of science awareness among masses: (in 200 Characters)*
Section of people getting the benefit: (in 100 Characters)*
Impact of the mentioned achievements: (in 200 Characters)*
3. Achievement Proposed for Consideration for the Award
Subject Area *
Field of achievement *
Broad area of activity : (please tick)
Details of the project done (in 300 words)*
Region(s) covered under the benefit*
Status *
Period of implementation*
funded by *
Target beneficiaries *
Approximate no. of beneficiaries*
Any specific section community served *
Organization(s) in collaboration*
Impact of the project mentioned: (in 200 words) *
Any other recognition received for the achievement mentioned:
|
. By Date
Future scope of expansion or replication: (in 200 words)*
Other noteworthy achievement(s) in the same field
|
Other awards received from the Government of West Bengal:
Name of the Award *
Received *
Date*
Applied *
Date*
Nominated *
Date *
Other assistance received from the Government of West Bengal *
Other assistance received from this Department earlier: *



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