Format (Revised)

INSPIRE Award Proposals Name of the State : Sr. No.

District

1

2

Sub Name of the District(Block/ School Tahsil/Zone etc.)

3

No of children selected from the school till 2009-10

4 School 1

Type Of Location School*(see Type Note below) (R/SU/U)

5

6

7

Group

Class

8

Name of the Sex (M/F) recommend ed Student in each Class

9

10

th

6 A [Class 6 7 8 9 B [Class 9th 10 School 2 6 A [Class 6th 7 8 9 B [Class 9th 10 School 3 6 A [Class 6th 7 8 9 B [Class 9th 10 Note: Depending upon the school structure available in each state, one may have suitable combination of Classes within Category.

SIGNATURES of THE AUTHORISED SIGNATORY NAME: DESIGNATION (with office Seal): Contact Numbers E:mail Note / Abbreviations: SG -State Government PA- Private Aided ( SG ) PUA- Private Unaided ( SG ) O_SG- Others ( SG ) KV -Kendriya Vidyalaya (Central School) NV- Navodaya Vidyalaya (Central Government) SS -Sainik School (Central Government) O_CG -Others (Central Government)

R- Rural SU- Semi -Urban U- Urban M -Male F -Female G -General SC -Scheduled Caste ST -Scheduled Tribe OBC -Other Backward Class

11

Category Father/ (G/SC/ST/O Mother BC) Name

12

13

Preferred Child Name(one Name from each Category of each School]

Selected Child ( to be filled in by DST)

14

15