B

BOMBAY NATURAL HISTORY SOCIETY & SERENITY LIBRARY

Presents

Management Capacity Development Programme for

Environmental NGOs
APPLICATION FORM
1. ABOUT THE ORGANIZATION
Name of the Head of Organisation: ___________________________________________
Designation: __________________________________________________
Name of the Organisation: __________________________________________________
Correspondence Address: _________________________________________________
_________________________________________________________________________
____________________________________________________ Pin: _________________
Contact No.: Office- _______________________ Mobile- __________________________
Email: ________________________________________________________
Registration Number and Date _______________________________________________
Mission Statement _________________________________________________________
_________________________________________________________________________
_________________________________________________________________________________
Core Activities ____________________________________________________________
__________________________________________________________________________
List Any 3 Achievements in Last 5 Years
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
Reasons of Joining the Programme? _________________________________________
_________________________________________________________________________
Anticipated Benefits for the Organization? ____________________________________
_________________________________________________________________________
Future Plans for Next Five Years? ____________________________________________
_________________________________________________________________________

Management Capacity Development Programme for

Environmental NGOs
_________________________________________________________________________

Management Capacity Development Programme for

Environmental NGOs
2.

NOMINATION OF EMPLOYEES

I wish to recommend following names of our employees for the programme

Photographs

1.

2.

Name:

Designation:

Working Since:
DD/MM/YY
Highest
Qualification:
Core Competencies:

Reasons for
Nomination:
Contact Number:
Email ID:
Age:
Gender:
Signature:
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Management Capacity Development Programme for

Environmental NGOs
3. TERMS AND CONDITIONS
i.

The programme is open only to employees of Environmental NGOs (eNGOs) from

Gujarat.

ii.

Any eNGO with good track record and in operation for more than three years can apply.

iii.

The head of eNGO can nominate any two mid-level employees who can be trained into
management master trainers for the organization. Please nominate one male and one
female candidate who are in service for at least two years.

iv.

The year long programme would include a commitment of five days for workshops (3day preliminary and 2-day follow up) in Ahmedabad and six-month virtual mentoring
phase with compulsory monthly assignments. It is compulsory to attend all workshops.

v.

Once the candidates are selected, the candidature cannot be transferred or cancelled
later during the programme. On successful completion a certificate will be awarded at
end of the programme to each participant.

vi.

The workshop assignments will include several real-time organizational developmental

issues which will be discussed openly with all participants, it is therefore important;
consent is given for usage of such organizational information.

vii.

The organization agrees to bear all participants costs related to programme.

viii.

All participants need to fill in a common application form for each organization. The
application form could be requested by sending an email to engosindia@gmail.com/
haseebdiddique@hotmail.com. A duly filled form should be submitted via email along
with a copy of detailed Curriculum Vitae. All applications will be scrutinized for the above
criteria and selected participants will be sent a confirmation.

ix.

The enrolment for the programme is FREE however a nominal fee of Rs.500/- is
charged towards food/refreshments and study materials during the workshops. The
payment is only required on confirmation of participation. This is a one time payment
only. The last date for application is 15 January 2013.

x.

The payment of fees can be made via cash/ cheque/ D.D. or online payment. Please
issue the D.D./ cheque in favour of V. Shubhalaxmi In case of online transfer please
contact us for details.

DECLARATION BY HEAD OF INSTITUTION

I, Mr. /Ms. /Dr. ________________________________________________________ hereby by
certify that Mr. /Ms. /Dr. ____________________________________________________and
Mr. /Ms. /Dr. ____________________________________________________are a bona fide
employee of our organization and have been nominated to participate in the programme as
representative of our organization______________________________. I have read the abovementioned terms and conditions and they are acceptable to me as well as to the participants. I
understand the participants need to attend the preliminary given during the mentoring phase. I
will allow them to successfully complete the programme and allow them to use organizational
information for their assignments. I also agree that he/ she has enlisted programme with his/ her
consent and at his/her own risk, and the BNHS/American Center/ Serenity Library shall not be
held responsible wholly or partly for any illness, mishap, injury or accident beyond their control.
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Management Capacity Development Programme for

Environmental NGOs
Date:
Place:

Signature of Head of Institution